Robotic versus thoraco-laparoscopic minimally invasive Ivor Lewis esophagectomy, a matched-pair single-center cohort analysis

Abstract

Minimally invasive esophagectomy (MIE) is becoming more widespread with a documented improvement in postoperative morbidity based on level I evidence. However, there is a lack of consensus regarding the optimal MIE approach, conventional thoracoscopy/laparoscopy vs robotics as well as the ideal anastomotic technique. All patients who underwent MIE via an Ivor Lewis approach with a side-to-side stapled anastomosis were included. The thoracoscopy-laparoscopy (TL) group was compared to the robotic group with respect to perioperative outcomes using the entire cohorts and after 1:1 propensity score matching. Comparisons were made using the Mann–Whitney U and Fisher’s exact tests. Between July 2013 and November 2020, 72 TL and 67 robotic Ivor Lewis MIE were performed. After comparing the two unadjusted cohorts and 51 propensity matched pairs, there was a decrease in Clavien-Dindo Grade 2 or above complications in the robotic vs TL group (59.7% vs 41.8% [P = 0.042], (62.7% vs 39.2% [P = 0.029]), respectively. In both analyses, there was a reduction in hospital length of stay (median of 8 vs 7 days, P < 0.001) and a trend toward less anastomotic leaks in the robotic group (Unadjusted: 12.5 vs 3% [P = 0.057], Propensity-matched analysis: 13.7% vs 3.9% [P = 0.16]), respectively. A clinically significant decrease in overall morbidity, cardiac complications and hospital length of stay was observed in the robotic Ivor Lewis cohort when compared with the TL group at a high volume MIE program. Side-to-side stapled thoracic anastomoses utilizing a robotic platform provides the best outcomes in this single institution experience.

Fully robotic side‐to‐side stapled anastomosis provides less anastomotic leakage than conventional minimally invasive approach in Ivor Lewis esophagectomy

“…In their experience, rates of anastomotic leakage have been favorable, ranging from 2% to 8% 22–24 . However, at this time, there are no prospective randomized trials comparing different ILE approaches (Open, CA and RA), and, including the current study, only five single‐center retrospective comparative studies have been reported 25–28 . Weindelmayer et al, 28 comparing the RA group of 47 cases with the Open group of 159 cases, reported a significantly longer operative time in the RA group, but similar rates of anastomotic leakage (RA 2.1% vs. Open 6.9%, p = .56) and a 90‐day mortality (RA 2.1% vs. Open 1.9%, p = .65).…”

“…[22][23][24] However, at this time, there are no prospective randomized trials comparing different ILE approaches (Open, CA and RA), and, including the current study, only five single-center retrospective comparative studies have been reported. [25][26][27][28] Weindelmayer et al, 28 comparing the RA group of 47 cases with the Open group of 159 cases, reported a significantly longer operative time in the RA group, but similar rates of anastomotic leakage (RA 2.1% vs. Open 6.9%, p = .56) and a 90-day mortality (RA 2.1% vs. Open 1.9%, p = .65). Regarding the comparison between RA and CA, Zhang et al 25 and Tagkalos et al 26 demonstrated no significant difference in leakage rates between the two groups, which was performed with a circular stapled or hand-sewn technique (Zhang et al: RA 7.6% vs. CA 4.5%, p = .727, Tagkalos et al: RA 12.5% vs. CA 12.5%, p = .966).…”

Mid-term outcomes of robotic-assisted versus video-assisted invasive minimally esophagectomy for esophageal cancer: A retrospective propensity-matched analysis of 842 patients

“…[9] In the following decade, many medical centers have reported the implementation of RAMIE. [5,10] Previous studies have shown that robot-assisted esophagectomy has better short-term outcomes compared with video-assisted thoracoscopic esophagectomy. [11] However, few studies have compared the mid -and long-term prognosis between RAMIE and VAMIE.…”

Prince and princesses: The current status of robotic surgery in surgical oncology

“…On multivariable analysis, conversion rate, margin positivity, and LN harvest remained superior in RAMIE 36 . Single‐center retrospective reviews have found similarly improved perioperative outcomes with a robotic approach 37 …”

“…36 Single-center retrospective reviews have found similarly improved perioperative outcomes with a robotic approach. 37…”