Robot-assisted transthoracic hybrid esophagectomy versus open and laparoscopic hybrid esophagectomy: propensity score matched analysis of short-term outcome

Abstract

Purpose Minimally invasive en-bloc esophagectomy is associated with a reduction of postoperative morbidity. This was demonstrated for both total minimally invasive and hybrid esophagectomy. However, little is known about any benefits of robotic assistance compared to the conventional minimally invasive technique, especially in hybrid procedures. Methods For this retrospective study, all consecutive patients who had undergone elective esophagectomy with circular stapled intrathoracic anastomosis using the open and the minimally invasive hybrid technique at the University Hospital Magdeburg, from January 2010 to March 2021 were considered for analysis. Results In total, 137 patients (60.4%) had undergone open esophagectomy. In 45 patients (19.8%), the laparoscopic hybrid technique and in 45 patients (19.8%), the robot-assisted hybrid technique were applied. In propensity score matching analysis comparing the open with the robotic hybrid technique, significant differences were found in favor of the robotic technique (postoperative morbidity, p < 0.01; hospital length of stay, p < 0.01; number of lymph nodes retrieved, p = 0.048). In propensity score matching analysis comparing the laparoscopic with the robotic hybrid technique, a significant reduction of the rate of postoperative delayed gastric emptying (p = 0.02) was found for patients who had undergone robotic esophagectomy. However, the operation time was significantly longer (p < 0.01). Conclusions En-bloc esophagectomy using the robotic hybrid technique is associated with a significant reduction of postoperative morbidity and of the hospital length of stay when compared to the open approach. However, when compared to the laparoscopic hybrid technique, only few advantages could be demonstrated.

Transanal total mesorectal excision (TaTME) in rectal cancer treatment within an expert center

“…To date, many studies have shown that minimally invasive techniques improve surgical outcomes in patients with gastrointestinal cancers [22][23][24]. Minimally invasive methods used in rectal cancer surgery include laparoscopic techniques, particularly LaTME, as performed from the abdominal access, and TaTME in which abdominal and transanal access are used simultaneously [13][14][15].…”

Transanal total mesorectal excision (TaTME) in rectal cancer treatment within an expert center

“…To date, many studies have shown that minimally invasive techniques improve surgical outcomes in patients with gastrointestinal cancers 22 – 24 . Minimally invasive methods used in rectal cancer surgery include laparoscopic techniques, particularly LaTME, as performed from the abdominal access, and TaTME in which abdominal and transanal access are used simultaneously 13 – 15 .…”