Robotic esophagectomy: the Moffitt Cancer Center experience

Amaral, Marisa; Pimiento, José M.; Fontaine, Jacques

doi:10.21037/acs.2017.03.21

Cited by 11 publications

(4 citation statements)

References 8 publications

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“…Surgical resection was performed in 2-stages in line with our general practice as previously described. 25 The described RAMIE cohort was comprised entirely from the experience of 3 surgeons, 2 within the department of gastrointestinal oncology and 1 within thoracic oncology. RAMIE comprises a significant portion of their practice with each surgeon contributing 133, 119, and 98 cases, respectively.…”

Section: Surgical Techniquementioning

confidence: 99%

Outcomes of 350 Robotic-assisted Esophagectomies at a High-volume Cancer Center

et al. 2020

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Objective:To evaluate perioperative and oncologic outcomes in our RAMIE cohort and compare outcomes with contemporary OE controls.Summary of Background Data:RAMIE has emerged as an alternative to traditional open or laparoscopic approaches. Described in all esophagectomy techniques, rapid adoption has been attributed to both enhanced visualization and technical dexterity.Methods:We retrospectively reviewed patients who underwent RAMIE for malignancy. Patient characteristics, perioperative outcomes, and survival were evaluated. For perioperative and oncologic outcome comparison, contemporary OE controls were propensity-score matched from NSQIP and NCDB databases.Results:We identified 350 patients who underwent RAMIE between 2010 and 2019. Median body mass index was 27.4, 32% demonstrated a Charlson Comorbidity Index >4. Nodal disease was identified in 50% of patients and 74% received neoadjuvant chemoradiotherapy. Mean operative time and blood loss were 425 minutes and 232 mL, respectively. Anastomotic leak occurred in 16% of patients, 2% required reoperation. Median LOS was 9 days, and 30-day mortality was 3%. A median of 21 nodes were dissected with 96% achieving an R0 resection. Median survival was 67.4 months. 222 RAMIE were matched 1:1 to the NSQIP OE control. RAMIE demonstrated decreased LOS (9 vs 10 days, P = 0.010) and reoperative rates (2.3 vs 12.2%, P = 0.001), longer operative time (427 vs 311 minutes, P = 0.001), and increased rate of pulmonary embolism (5.4% vs 0.9%, P = 0.007) in comparison to NSQIP cohort. There was no difference in leak rate or mortality. Three hundred forty-three RAMIE were matched to OE cohort from NCDB with no difference in median overall survival (63 vs 53 months; P = 0.130).Conclusion:In this largest reported institutional series, we demonstrate that RAMIE can be performed safely with excellent oncologic outcomes and decreased hospital stay when compared to the open approach.

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Section: Surgical Techniquementioning

confidence: 99%

Outcomes of 350 Robotic-assisted Esophagectomies at a High-volume Cancer Center

et al. 2020

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“…The latest iteration of these advances includes the adoption of robotic techniques which over the last 10 years have become more ubiquitous. We have previously published our robotic-assisted (thoracic portion) esophagectomy experience which was made up of a significant proportion of hybrid procedures utilizing an open abdominal approach ( 9 , 15 ). Here we focus on the surgical technique and outcomes for a completely minimally invasive approach.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first minimally invasive, thoracoscopic esophagectomy was performed by Alfred Cuschieri in 1992 ( 1 ), laparoscopic and robotic techniques have come to the forefront ( 7 , 8 ) and were adopted at our institution starting in 2010 ( 9 , 10 ). This is due, in large part, to evidence suggesting that minimally invasive approaches improve surgical outcomes when compared to open approaches ( 7 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Totally minimally invasive laparoscopic robot-assisted Ivor Lewis esophagectomy: improved technique and outcomes over 200 cases

Drake,

Sinnamon,

Saeed

et al. 2024

J Gastrointest Oncol

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Background Surgical resection of esophageal and gastroesophageal junction cancers is a very complex procedure with step learning curve. New technologies have made minimally invasive surgery possible, but challenges still remain for wide spread adoption of these techniques. This article aims to describe the outcomes and salient technical points of a totally minimally invasive, laparoscopic, robot-assisted Ivor Lewis esophagectomy (LRAMIE). Methods Retrospective observational cohort study performed at a specialty cancer center using a prospectively maintained institutional database. Patients undergoing LRAMIE (laparoscopic abdomen, robotic chest) from 2014–2023 were included. Patients undergoing transhiatal and three-field esophagectomy were excluded. Operative and postoperative outcomes were compared over the study period to identify potential associations between outcomes over time. Results Two-hundred patients were identified who underwent LRAMIE. Median age was 65 years and most were male (87.5%). The open conversion rate was 1% (n=2), which occurred within the first 30 cases. Operative time and blood loss were improved at the 60-case mark (P<0.001). Anastomotic stricture rate improved after 50 cases, and leak rate improved after 80 cases. Postoperative length of stay improved at both 50 and 100 cases with a median LOS of 6 days after 100 cases. Rate of postoperative pneumonia, 30- and 90-day mortality were reduced after 100 cases, although not statistically significant for mortality due to too few events. Conclusions Totally minimally invasive Ivor Lewis esophagectomy at a high-volume center is a safe procedure. Operative outcomes improved significantly after 50–80 cases, followed by improvement in anastomotic results and postoperative outcomes, with corresponding excellent oncologic outcomes.

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“…The robotic approach to esophagectomy has been described by several authors (24,25), and was the object of a recent large review by Harbison et al comparing outcomes of robotic assisted versus non-robotic minimally invasive esophagectomy for esophageal cancer using the NSQIP database. They found robotic esophagectomy to be feasible on a larger scale with outcome similar to the standard of care regarding adequacy of the oncologic resection and complications (26).…”

Section: Role Of Robotic Surgerymentioning

confidence: 99%

Robotic/thoracoscopic approach to esophageal gastro-intestinal stromal tumor

Herbert¹,

McGinn²,

Maloney³

et al. 2020

Shanghai Chest

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Gastro-intestinal stromal tumor (GIST) of the esophagus are rare and account for only 1-2% of all GIST. As a result, there is a lack of clear guidelines regarding their optimal management. Previously mistaken for leiomyomas or leiomyosarcomas, it is relatively recently that their origin from the interstitial cells of Cajal was identified, when their expression of double expression C-Kit and CD34 was discovered.They are submucosal tumors, and their presentation is non-specific, with dysphagia being the most frequent symptoms. They appear as well defined iso or hypoattenuating round tumor with smooth sharp edges on computed tomography, and differ from leiomyoma by being fluorodeoxyglucose (FDG) avid on positron emission tomography. Surgical resection is the mainstay of treatment, however, indications and modality of resection are topic of debate. Due to high morbidity of esophagectomy, minimally invasive solutions are appealing. In this review, we propose a general overview of esophageal GIST, and a discussion the different surgical options.

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Robotic esophagectomy: the Moffitt Cancer Center experience

Cited by 11 publications

References 8 publications

Outcomes of 350 Robotic-assisted Esophagectomies at a High-volume Cancer Center

Outcomes of 350 Robotic-assisted Esophagectomies at a High-volume Cancer Center

Totally minimally invasive laparoscopic robot-assisted Ivor Lewis esophagectomy: improved technique and outcomes over 200 cases

Robotic/thoracoscopic approach to esophageal gastro-intestinal stromal tumor

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