Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2021

01-02-2021 | Esophageal Cancer | Thoracic Oncology

Lower Incidence of Postoperative Pulmonary Complications Following Robot-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: Propensity Score-Matched Comparison to Conventional Minimally Invasive Esophagectomy

Authors: Shigeru Tsunoda, MD, PhD, FACS, Kazutaka Obama, MD, PhD, FACS, Shigeo Hisamori, MD, PhD, FACS, Tatsuto Nishigori, MD, PhD, FACS, Ryosuke Okamura, MD, PhD, Hisatsugu Maekawa, MD, PhD, Yoshiharu Sakai, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 2/2021

Login to get access

Abstract

Background

Whether robot-assisted minimally invasive surgery (RAMIE) is more beneficial than conventional minimally invasive surgery (MIE) remains unclear.

Methods

In total, 165 consecutive patients with esophageal carcinoma who underwent esophagectomy between January 2015 and April 2020 were retrospectively assessed. A 1:1 propensity score matching analysis was performed to compare the short-term outcomes between RAMIE and conventional MIE.

Results

After matching, 45 patients were included in the RAMIE and conventional MIE groups. RAMIE had a significantly longer total operative time (708 vs. 612 min, P < 0.001) and thoracic operative time (348 vs. 285 min, P < 0.001) than conventional MIE. However, there were no significant differences in terms of oncological outcomes, such as R0 resection rate and number of resected lymph nodes. The overall postoperative morbidity (Clavien–Dindo [C–D] grade II or higher) rate of RAMIE and conventional MIE were 51% and 73% (P = 0.03), respectively, and the severe postoperative morbidity (C–D grade III or higher) rates were 11% and 29% (P = 0.04), respectively. The incidence rate of recurrent laryngeal nerve palsy was halved in RAMIE (7%) compared with conventional MIE (20%) (P = 0.06). Finally, the pulmonary complication rate (18%) was significantly lower in patients who underwent RAMIE than in those who underwent conventional MIE (44%) (P = 0.006).

Conclusions

RAMIE was safe and feasible, even during the early period of its application at a specialized center. Moreover, it may be a promising alternative to conventional MIE, with better short-term outcomes, including significantly lower incidence of pulmonary complications.
Literature
1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.PubMedCrossRef
2.
Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus. 2019;16(1):25–43.PubMedCrossRef
3.
Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37(1):7–11.PubMed
4.
Bodner J, Wykypiel H, Wetscher G, Schmid T. First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg. 2004;25(5):844–51.PubMedCrossRef
5.
van Hillegersberg R, Boone J, Draaisma WA, Broeders IA, Giezeman MJ, Borel Rinkes IH. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc. 2006;20(9):1435–9.PubMedCrossRef
6.
Dapri G, Himpens J, Cadière GB. Robot-assisted thoracoscopic esophagectomy with the patient in the prone position. J Laparoendosc Adv Surg Tech A. 2006;16(3):278–85.PubMedCrossRef
7.
Ruurda JP, Draaisma WA, van Hillegersberg R, et al. Robot-assisted endoscopic surgery: a four-year single-center experience. Dig Surg. 2005;22(5):313–20.PubMedCrossRef
8.
Espinoza-Mercado F, Imai TA, Borgella JD, et al. Does the approach matter? Comparing survival in robotic, minimally invasive, and open esophagectomies. Ann Thorac Surg. 2019;107(2):378–85.PubMedCrossRef
9.
Tsunoda S, Shinohara H, Kanaya S, et al. Mesenteric excision of upper esophagus: a concept for rational anatomical lymphadenectomy of the recurrent laryngeal nodes in thoracoscopic esophagectomy. Surg Endosc. 2020;34(1):133–41.PubMedCrossRef
10.
Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Hoboken; 2016.
11.
Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edn: part I. Esophagus. 2017;14(1):1–36.CrossRef
12.
Tanaka E, Okabe H, Kinjo Y, et al. Advantages of the prone position for minimally invasive esophagectomy in comparison to the left decubitus position: better oxygenation after minimally invasive esophagectomy. Surg Today. 2015;45(7):819–25.PubMedCrossRef
13.
Tanaka E, Okabe H, Tsunoda S, et al. Feasibility of thoracoscopic esophagectomy after neoadjuvant chemotherapy. Asian J Endosc Surg. 2012;5(3):111–7.PubMedCrossRef
14.
Okabe H, Tanaka E, Tsunoda S, Obama K, Sakai Y. Intrathoracic esophagogastric anastomosis using a linear stapler following minimally invasive esophagectomy in the prone position. J Gastrointest Surg. 2013;17(2):397–402.PubMedCrossRef
15.
16.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedPubMedCentralCrossRef
17.
Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015;262(2):286–94.PubMedCrossRef
18.
D’Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265–81.PubMedCrossRef
19.
Zhang Y, Han Y, Gan Q, et al. Early outcomes of robot-assisted versus thoracoscopic-assisted Ivor Lewis esophagectomy for esophageal cancer: A propensity score-matched study. Ann Surg Oncol. 2019;26(5):1284–91.PubMedCrossRef
20.
21.
Park S, Hwang Y, Lee HJ, Park IK, Kim YT, Kang CH. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis. 2016;8(10):2853–61.PubMedPubMedCentralCrossRef
22.
Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg. 2012;36(7):1608–16.PubMedCrossRef
23.
Jin D, Yao L, Yu J, et al. Robotic-assisted minimally invasive esophagectomy versus the conventional minimally invasive one: a meta-analysis and systematic review. Int J Med Robot. 2019;15(3):e1988.PubMedCrossRef
24.
Mu L, Yang S. An experimental study on the laryngeal electromyography and visual observations in varying types of surgical injuries to the unilateral recurrent laryngeal nerve in the neck. Laryngoscope. 1991;101(7 Pt 1):699–708.PubMed
25.
Lombardi CP, D’Alatri L, Marchese MR, et al. Prospective electromyographic evaluation of functional postthyroidectomy voice and swallowing symptoms. World J Surg. 2012;36(6):1354–60.PubMedCrossRef
26.
Louie BE, Farivar AS, Aye RW, Vallières E. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg. 2012;93(5):1598–604; discussion 604–5.
27.
Kataoka K, Takeuchi H, Mizusawa J, et al. Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. 2017;265(6):1152–7.PubMedCrossRef
28.
Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264(2):305–11.PubMedCrossRef
29.
Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine (Baltimore). 2015;94(33):e1369.PubMedPubMedCentralCrossRef
30.
Park SY, Kim DJ, Kang DR, Haam SJ. Learning curve for robotic esophagectomy and dissection of bilateral recurrent laryngeal nerve nodes for esophageal cancer. Dis Esophagus. 2017;30(12):1–9.PubMedCrossRef
31.
Park S, Hyun K, Lee HJ, Park IK, Kim YT, Kang CH. A study of the learning curve for robotic oesophagectomy for oesophageal cancer. Eur J Cardiothorac Surg. 2018;53(4):862–70.PubMedCrossRef
32.
Zhang H, Chen L, Wang Z, et al. The learning curve for robotic McKeown esophagectomy in patients with esophageal cancer. Ann Thorac Surg. 2018;105(4):1024–30.PubMedCrossRef
33.
van der Sluis PC, Ruurda JP, van der Horst S, Goense L, van Hillegersberg R. Learning curve for robot-assisted minimally invasive thoracoscopic esophagectomy: results from 312 cases. Ann Thorac Surg. 2018;106(1):264–71.PubMedCrossRef
34.
Okabe H, Obama K, Tsunoda S, et al. Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today. 2019;49(10):820–7.PubMedCrossRef
Metadata
Title
Lower Incidence of Postoperative Pulmonary Complications Following Robot-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: Propensity Score-Matched Comparison to Conventional Minimally Invasive Esophagectomy
Authors
Shigeru Tsunoda, MD, PhD, FACS
Kazutaka Obama, MD, PhD, FACS
Shigeo Hisamori, MD, PhD, FACS
Tatsuto Nishigori, MD, PhD, FACS
Ryosuke Okamura, MD, PhD
Hisatsugu Maekawa, MD, PhD
Yoshiharu Sakai, MD, PhD, FACS
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09081-6

Other articles of this Issue 2/2021

Annals of Surgical Oncology 2/2021 Go to the issue

ASO Author Reflections

ASO Author Reflections: Head and Neck Cancer Surgery—How Long Can it Wait?

Melanoma

The Clinical Utility of Neuron-Specific Enolase (NSE) Serum Levels as a Biomarker for Merkel Cell Carcinoma (MCC)

Thoracic Oncology

Refusal of Local Therapy in Esophageal Cancer and Impact on Overall Survival

Head and Neck Oncology

Time to Surgery and Survival in Head and Neck Cancer

Hepatobiliary Tumors

Tumor Necrosis in Hepatocellular Carcinoma—Unfairly Overlooked?

Translational Research and Biomarkers

Distal Gastrectomy with Billroth II Reconstruction is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: A Proof-of-Concept Study