Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Abstract

Background Robot-assisted minimally invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE procedures using the da Vinci Xi robotic system 4-arm technique. Methods Data of 100 consecutive patients with esophageal or gastro-esophageal junction carcinoma undergoing modified Ivor Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management. Intraoperative and postoperative complications were graded according to Esophagectomy Complications Consensus Group (ECCG) definitions. Results Mean duration was 416 min (±80); 70% of patients had an uncomplicated postoperative recovery. Pulmonary complications were observed in 17% of patients. Anastomotic leakage was observed in 8% of patients. Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. The 30-day mortality was 1%; 90-day mortality was 3%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. All patients had at least 7 months of followup with a median follow-up of 17 months. Median overall survival was not reached yet. Conclusion RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer was technically feasible and safe. Postoperative complications and short-term oncologic results were comparable to the highest international standards nowadays. Keywords Esophageal cancer. Minimally invasive. MIE. RAMIE. Ivor Lewis Synopsis RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer is technically feasible and safe. Postoperative complications and shortterm oncologic results were comparable to the highest international standards nowadays.

Minimally invasive esophagectomy: clinical evidence and surgical techniques

“…Thereby, the robotic system offers some unique advantages not reached by the conventional minimal invasive approach. Our own data of the first 100 roboticassisted Ivor-Lewis esophagectomies with intrathoraciccreated end-to-end circular-stapled anastomoses suggest leakage rates of 8% [51,52]. These numbers hint at lower leakage rates compared with leakage rates around 24% of OE and Mc Keown procedures with neck anastomoses [53].…”

“…RAMIE offers meticulous and safe dissection in delicate regions allowing sufficient extent of lymphadenectomy even in highly complex cases, e.g., after neoadjuvant treatment or definitive radiation. The group in our institution found an average of 28 lymph nodes resected using the Davinci Xi [52] and a trend towards improved lymphadenectomy in RAMIE compared with MIE [61]. In RAMIE, the possibility of near-infrared fluorescent imaging (NIR) is additionally helpful: either preoperatively injected labeled colloid or indocyanine green dye (ICG) in submucosa can visually support the identification of lymph nodes or vessel [62].…”

Robotische Ösophaguresektion (RAMIE) – Setup, Port Placement, strukturierte OP-Schritte

“…Absolut gesehen zeigten sich in dieser Studie relativ hohe Komplikationsraten in beiden Gruppen, insbesondere die angegebene Anastomoseninsuffizienzrate von 24 % in der robotischen Gruppe erscheint vergleichsweise hoch. Eigene Daten zeigen diesbezüglich vielversprechendere Ergebnisse (in Review), auch durch andere Arbeitsgruppen wurden Ergebnisse mit deutlich geringeren Komplikationsraten (Insuffizienzrate 8 %) nach RAMIE publiziert [12]. Es bleibt abzuwarten, ob durch die wachsende Expertise an den einzelnen Zentren nach Abschluss der Lernkurve noch eine weitere für den Patienten relevante Verbesserung des postoperativen Outcomes zu erwarten ist.…”

Robotic esophagectomy: how I do it?

“…Recent large cohort studies have found an average harvest of 25-29 regional nodes during RAMIE [15,21,22] . Rates of locoregional recurrence, however, are not well defined, as the studies do not differentiate local and distant recurrences when determining disease-free survival.…”