Robot-assisted minimally invasive esophagectomy: systematic review on surgical and oncological outcomes

Abstract

Aim: Esophagectomy is associated with several post-operative complications (50%-70%) due to surgical trauma. Minimally invasive techniques have therefore been applied to decrease mortality and morbidity. Robotassisted minimally-invasive esophagectomy (RAMIE) was developed to overcome the drawbacks of the thoracolaparoscopic approach. The objective of this systematic review is to report some recent experiences and to compare RAMIE with other approaches to esophagectomy, focusing on technical and oncological aspects.Methods: Pubmed, Embase and Scopus databases were searched for "robot-assisted esophagectomy", "minimally invasive esophagectomy" and "robotic esophagectomy" in January 2020. The study was focused on original papers on totally endoscopic RAMIE in the English language. No statistical procedures (meta-analysis) were performed.Results: Three hundred and twenty studies were identified across the database and after screening and reviewing, 14 were included for final analysis. The overall 90-day post-operative mortality after trans-thoracic esophagectomy ranged from 0% to 9% and did not differ between approaches. Post-operative complications ranged between 24% and 60.9%: respiratory (6.25% to 65%), cardiac (0.8% to 32%), anastomotic leak (3.1% and 37.5%) and vocal cord palsy (9.1%-35%) were the most frequent. The evidence for long-term outcomes is weak, with no significant differences in overall survival, disease-free survival and recurrence identified in comparison with other approaches. The selected papers showed that RAMIE had comparable outcomes between the open and thoraco-laparoscopic approaches within a multimodal treatment pathway. Conclusion:RAMIE also seems to be associated with better lymph node dissection, nerve sparing and quality of life, but larger studies are needed to obtain more evidence.

Robotic Surgery in Oncology

“…As far as evidence is concerned, there are systematic reviews and meta-analyses regarding the feasibility, oncological safety, learning curve, and functional outcomes. Presently all the studies have shown comparable short-term outcome, less conversion rate, and marginal benefit of robotic surgery in carcinoma rectum and esophagus [4,5]. Same is true for nerve sparing radical prostatectomy and nephron sparing nephrectomy.…”