Outcomes of robotic esophagectomy

Abstract

Esophagectomy has long been considered the standard of care for early-stage (≤ T2N0) esophageal cancer. Minimally invasive esophagectomy (MIE), using a combined laparoscopic and thoracoscopic approach, was first performed in the 1990s and showed significant improvements over open approaches. Refinement of MIE arrived in the form of robotic-assisted minimally invasive esophagectomy (RAMIE) in 2004. MIE is a challenging procedure for which consensus on optimal technique is still elusive.Although nonrobotic MIE confers significant advantages over open approaches, MIE remains associated with stubbornly high rates of complications, including pneumonia, aspiration, arrhythmia, anastomotic leakage, surgical site infection, and vocal cord palsy. RAMIE was envisioned to improve operative-associated morbidity while achieving equivalent or superior oncologic outcomes to nonrobotic MIE. However, owing to RAMIE's significant upfront costs, steep learning curve, and other requirements, adoption remains less than widespread and convincing evidence supporting its use from well-designed studies is lacking. In this review, we compare operative, oncologic, and quality-of-life outcomes between open esophagectomy, nonrobotic MIE, and RAMIE. Although RAMIE remains a relatively new and underexplored modality, several studies in the literature show that it is feasible and results in similar outcomes to other MIE approaches. Moreover, RAMIE has been associated with favorable patient satisfaction and quality of life.

The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes?

“…This is a significant parameter that should be evaluated when interpreting the outcomes of the recent publication of the Esodata Study Group as well [36]. Interestingly, RAMIE, which is another technically demanding procedure, was also introduced to the esophageal surgical society over the same time period and evolved over the past two decades [37]. Throughout the years, most of the specialized centers around the world focused on mastering either MIE or RAMIE, as each approach requires a challenging learning curve.…”

Today’s Mistakes and Tomorrow’s Wisdom in the Surgical Treatment of Barrett’s Adenocarcinoma

“…Finally, concerning postoperative QoL, there is a general agreement in favor of both MIE and RAMIE for the domains "global QoL," "physical functioning," "fatigue," and "pain" [88][89][90]. However, it is still controversial if those advantages remains significant during long-term follow-up [66,[90][91][92][93][94][95]. Surprisingly, QoL of patients undergoing esophagectomy is restored to baseline level in 12 months, irrespective of the occurrence of postoperative complications such as anastomotic leakage [96].…”

Comparison of Quality of Life after Robotic, Video-Assisted, and Open Surgery for Lung Cancer

“…Lung cancer continues to be the most prevalent cancer globally, with surgery remaining the standard treatment for early-stage cases. Technological advancements have shifted surgical approaches from open procedures to minimally invasive surgeries, such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) [1,2]. However, these two methods have significant differences.…”

“…However, these two methods have significant differences. VATS has faced criticism for its limited manoeuvrability and reliance on a two-dimensional screen [1][2][3][4]. Consequently, RATS has gained attraction, addressing many VATS challenges by providing 360-degree articulation and a three-dimensional operating environment [1,2,5].…”

“…VATS has faced criticism for its limited manoeuvrability and reliance on a two-dimensional screen [1][2][3][4]. Consequently, RATS has gained attraction, addressing many VATS challenges by providing 360-degree articulation and a three-dimensional operating environment [1,2,5]. These advantages may offer RATS an oncological edge, facilitating improved nodal resection [1,[6][7][8] and enabling more complex procedures, thus reducing VATS conversion rates [7,9].…”