Short- and mid-term outcomes of robotic versus thoraco-laparoscopic McKeown esophagectomy for squamous cell esophageal cancer: a propensity score-matched study

Abstract

SUMMARY Controversy exists on the advantages of robotic McKeown esophagectomy (RME) versus thoraco-laparoscopic McKeown esophagectomy (TLME). The aim was to evaluate the short- and mid-term outcomes of RME and TLME in the treatment of patients with esophageal squamous cell carcinoma (ESCC). A consecutive series of 652 patients, 280 in RME and 372 in TLME, who underwent minimally invasive McKeown esophagectomy for ESCC at our department from November 2015 to June 2018 was analyzed. A propensity score-matched comparison with clinicopathological covariates was performed between the two groups. Complications were categorized based on the Esophagectomy Complications Consensus Group (ECCG) recommendation. To identify the recurrence, all patients with R0 resection were followed with a median follow-up period of 20.2 months (range 1–33 months). After propensity score matching, 271 patients were identified for each cohort. In the matched cohorts, two patients died within 90 days in TLME, whereas no patients died in RME. RME was associated with similar intraoperative blood loss (P = 0.895), but with shorter surgical duration (244.5 vs. 276.0 min, P < 0.001), shorter thoracic duration (85.0 vs. 102.9 min, P < 0.001) and lower thoracic conversions (0.7% vs. 5.9%, P = 0.001). In spite of the similar results on total and thoracic lymph nodes dissection, RME yielded more lymph nodes along recurrent laryngeal nerve (4.8 vs. 4.1, P = 0.012), as well as the higher incidence of recurrent nerve injury (29.2% vs. 15.1%, P < 0.001) when compared to TLME. Tumor recurrence occurred in 30 patients and was locoregional only in 9 (3.5%) patients, systemic only in 17 (6.7%) patients, and combined in 4 (1.6%) patients in RME, while in 26 patients and was locoregional only in 10 (10.6%) patients, systemic only in 7 (2.8%) patients, and combined in 9 (3.6%) patients in TLME. RME was associated with a lower rate of mediastinal lymph nodes recurrence (2.0% vs. 5.3%, P = 0.044). Overall and disease-free survival was not different between the two cohorts (P = 0.097 and P = 0.248, respectively). RME was shown to be a safe and oncologically effective approach with favorable short- and mid-term outcomes in the treatment of patients with ESCC.

Lymph node dissection around left recurrent laryngeal nerve: robot-assisted vs. video-assisted McKeown esophagectomy for esophageal squamous cell carcinoma

“…With respect to total LDN, Park et al [11] and Deng et al [30] retrospectively found that robot-assisted esophagectomy yielded more dissected lymph nodes than conventional MIE. However, several recent studies together with our study demonstrated that the number of total dissected lymph nodes was comparable between the two surgical approaches [13,21].…”

“…Theoretically, RAME achieves better short-term and oncological results than traditional MIE [ 21 ]. Using a magnified three-dimensional image, articulating forceps, and tremor filtering, RAME can overcome some limitations of traditional MIE.…”

Optimal preoperative neoadjuvant therapy for resectable locally advanced esophageal squamous cell carcinoma

“…58 A propensity score-matched comparison between 280 cases of robot-assisted MIE and 372 cases of thoracolaparoscopic MIE also showed promising safe and oncologically effective approaches with favorable short-and midterm outcomes in ESCC. 59 Therefore, it is assumed that the combination of NCRT with MIE may reduce postoperative morbidity and mortality. The ongoing CMISG1701 trial is a multicenter, prospective, randomized, phase III clinical trial, which was designed to confirm whether NCRT + MIE could yield better survival and decrease postoperative morbidity and mortality in patients with resectable locally advanced ESCC.…”

Influence of Induction Therapy on Robot-Assisted McKeown Esophagectomy for Esophageal Squamous Cell Carcinoma

“…The advantages of robot-assisted MIE over video-assisted MIE are mainly reflected in the dissection of upper mediastinal lymph nodes and the protection of the RLN. In 2019, Yang et al [24]reported a consecutive series of 652 patients, 280 in robot MIE and 372 in video MIE, who underwent minimally invasive McKeown esophagectomy for ESCC. In spite of the similar results on total and thoracic lymph node dissection, robot-assisted MIE yielded more lymph nodes along the RLN (4.8 vs. 4.1, p = 0.012), as well as the higher incidence of recurrent nerve injury (29.2 vs. 15.1%, p < 0.001) when compared to TLME.…”