Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial

Abstract

Purpose Robotic-assisted minimally invasive esophagectomy (RAMIE) has become one standard approach for the operative treatment of esophageal tumors at specialized centers. Here, we report the results of a prospective multicenter registry for standardized RAMIE. Methods The German da Vinci Xi registry trial included all consecutive patients who underwent RAMIE at five tertiary university centers between Oct 17, 2017, and Jun 5, 2020. RAMIE was performed according to a standard technique using an intrathoracic circular stapled esophagogastrostomy. Results A total of 220 patients were included. The median age was 64 years. Total minimally invasive RAMIE was accomplished in 85.9%; hybrid resection with robotic-assisted thoracic approach was accomplished in an additional 11.4%. A circular stapler size of ≥28 mm was used in 84%, and the median blood loss and operative time were 200 (IQR: 80–400) ml and 425 (IQR: 335–527) min, respectively. The rate of anastomotic leakage was 13.2% (n=29), whereas the two centers with >70 cases each had rates of 7.0% and 12.0%. Pneumonia occurred in 19.5% of patients, and the 90-day mortality was 3.6%. Cumulative sum analysis of the operative time indicated the end of the learning curve after 22 cases. Conclusions High-quality multicenter registry data confirm that RAMIE is a safe procedure and can be reproduced with acceptable leak rates in a multicenter setting. The learning curve is comparably low for experienced robotic surgeons.

Time to endoscopic vacuum therapy—lessons learned after > 150 robotic-assisted minimally invasive esophagectomies (RAMIE) at a German high-volume center

“…Our study cohort showed an ECCG AL type II in 21 of 157 patients (13.4%) after IL RAMIE. This corresponds to the data by van der Sluis et al, Pointer et al, and Egberts et al, who report a leak rate of 11, 13.5, and 13.2%, respectively [26][27][28]. Compared to the studies of the DCDP Database and the ESO Benchmark database which report an AL rate of 15 and 15.9%, IL RAMIE showed a lower AL rate.…”

C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies

“…Previously, it has been shown that early detection of PIC is essential not only for the treatment of complications but also for patient survival [ 20 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. PICs, according to the definition used for this paper, include surgical site infections, pneumonia, pleural empyema, leakage or necrosis of the gastric conduit, and anastomotic leakage [ 33 , 39 ].…”

“…In particular, patients with a previous history of smoking seem to be more susceptible to postoperative pulmonary complications [ 42 ]. It was postulated that less invasive and shorter procedures, especially for the thoracic part of the procedure, would cause fewer pulmonary infectious complications [ 34 , 43 , 44 , 45 , 46 ]. Glatz et al found HMIE to cause lesser pulmonary and overall complications, compared to OE, without taking infectious parameters into consideration [ 47 ].…”

Robot-assisted Ivor Lewis Esophagectomy (RAILE): A review of surgical techniques and clinical outcomes

“…We found that 51 cases were the baseline to achieve acceptable surgical outcomes and proficiency and 73 cases were needed to further make a difference in blood loss and LN yield (49). In comparison, the 22nd case represented the inflection point, resulting in less blood loss, shorter operative time, and a lower rate of postoperative pneumonia in German multicenter research (29). We thus speculate the Upper GI International Robotic Association (URIGA) structured training pathway implemented in Germany may be a crucial factor.…”

“…Common complications related to esophagectomy include anastomotic leakage, pulmonary complications (such as pneumonia, respiratory failure, pleural effusion, and pneumothorax), vocal cord paralysis, severe cardiac complications (mainly arrhythmia), chylothorax, and wound infection. The anastomotic leak rate ranges from 1.9 to 19.6% (4,8,11,22,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Despite using different anastomotic methods, some centers had leak incidences of less than 5%, suggesting the underlying importance of personal proficiency.…”