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16-05-2024 | Esophagus Resection

Technical feasibility and oncological outcomes of robotic esophagectomy compared with conventional thoracoscopic esophagectomy for clinical T3 or T4 locally advanced esophageal cancer: a propensity-matched analysis

Authors: Hiroyuki Daiko, Junya Oguma, Koshiro Ishiyama, Daisuke Kurita, Kentaro Kubo, Yuto Kubo, Daichi Utsunomiya, Shota Igaue, Ryoko Nozaki, Xue-Feng Leng, Takeo Fujita, Hisashi Fujiwara

Published in: Surgical Endoscopy | Issue 7/2024

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Abstract

Background

Minimally invasive esophagectomy is the first-line approach for esophageal cancer; however, there has recently been a paradigm shift toward robotic esophagectomy (RE). We investigated the clinical outcomes of patients who underwent RE compared with those of patients who underwent conventional minimally invasive thoracoscopic esophagectomy (TE) for locally advanced cT3 or cT4 esophageal cancer using a propensity-matched analysis.

Methods

Overall, 342 patients with locally advanced cT3 or cT4 esophageal cancer underwent transthoracic esophagectomy with total mediastinal lymph node dissection between 2018 and 2022. The propensity-matched analysis was performed to assign the patients to either RE or TE by covariates of histological type, tumor location, and clinical N factor.

Results

Overall, 87 patients were recruited in each of the RE and TE groups according to the propensity-matched analysis. The total complication rate and the rates of the three major complications (recurrent laryngeal nerve paralysis, anastomotic leakage, and pneumonia) were not significantly different between the RE and TE groups. However, the peak C-reactive protein concentration on postoperative day 3, rate of surgical site infection, and intensive care unit length of stay after surgery were significantly shorter in the RE group than in the TE group. No significant differences were observed in the harvested total and mediastinal lymph nodes. The total operation time was significantly longer in the RE group, while the thoracic operation time was shorter in the RE group than in the TE group. There was no significant difference between the two groups in the recurrence rate of oncological outcomes after surgery.

Conclusion

RE may facilitate early recovery after esophagectomy with total mediastinal lymph node dissection and has the same technical feasibility and oncological outcomes as TE.
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Metadata
Title
Technical feasibility and oncological outcomes of robotic esophagectomy compared with conventional thoracoscopic esophagectomy for clinical T3 or T4 locally advanced esophageal cancer: a propensity-matched analysis
Authors
Hiroyuki Daiko
Junya Oguma
Koshiro Ishiyama
Daisuke Kurita
Kentaro Kubo
Yuto Kubo
Daichi Utsunomiya
Shota Igaue
Ryoko Nozaki
Xue-Feng Leng
Takeo Fujita
Hisashi Fujiwara
Publication date
16-05-2024
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-10872-1

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