Advertisement

Comparative outcomes of minimally invasive and robotic-assisted esophagectomy

  • Kenneth MeredithEmail author
  • Paige Blinn
  • Taylor Maramara
  • Caitlin Takahashi
  • Jamie Huston
  • Ravi Shridhar
Article

Abstract

Objective

Minimally invasive esophagectomy (MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The addition of robotics to esophageal resection has potential benefits. We sought to examine the outcomes with MIE to include robotics.

Methods

Utilizing a prospective esophagectomy database, we identified patients who underwent (MIE) Ivor Lewis via thoracoscopic/laparoscopic (TL), transhiatal (TH), or robotic-assisted Ivor Lewis (RAIL). Patient demographics, tumor characteristics, and complications were analyzed via ANOVA, χ2, and Fisher exact where appropriate.

Results

We identified 302 patients who underwent MIE: TL 95 (31.5%), TH 63 (20.8%), and RAIL 144 (47.7%) with a mean age of 65 ± 9.6. The length of operation was longer in the RAIL: TL (299 ± 87), TH (231 ± 65), RAIL (409 ± 104 min), p < 0.001. However, the EBL was lower in the patients undergoing transthoracic approaches (RAIL + TL): TL (189 ± 188 ml), TH (242 ± 380 ml), RAIL (155 ± 107 ml), p = 0.03. Conversion to open was also lower in these patients: TL 7 (7.4%), TH 8 (12.7%), RAIL 0, p < 0.001. The R0 resection rate and lymph node (LN) harvest also favored the RAIL cohort: TL 86 (93.5%), TH 60 (96.8%), and RAIL 144 (100%), p = 0.01; LN: TL 14 ± 7, TH 9 ± 6, and RAIL 20 ± 9, p < 0.001. The overall morbidity was lower in MIE patients that underwent a transthoracic approach vs. transhiatal: TL 29 (30.5%), TH 39 (61.9%), RAIL 34 (23.6%), p < 0.001.

Conclusions

Patients undergoing MIE via thoracoscopic/laparoscopic and robotic transthoracic approaches demonstrated lower EBL, morbidity, and conversion to open compared to the transhiatal approach. Additionally the oncologic outcomes measured by R0 resections and LN harvest also favored the patients who underwent a transthoracic approach.

Keywords

Transhiatal esophagectomy Transthoracic esophagectomy Robotic esophagectomy 

Notes

Author contributions

CT: Concept and design, data analysis, manuscript writing, and final approval. RS: Concept and design, data analysis and interpretation, manuscript writing, and final approval. JH: Collection and assembly of data and final approval. KM: Concept and design, data analysis and interpretation, manuscript writing, and final approval. PB: Data analysis, manuscript writing, and final approval. TM: Data analysis, manuscript writing, and final approval.

Compliance with ethical standards

Disclosures

Dr. Meredith, Dr. Takahashi, Dr. Shridhar, Ms. Blinn, Ms. Maramara, and Ms. Huston have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Zhang Y (2013) Epidemiology of esophageal cancer. World J Gastroenterol 19(34):5598–5606CrossRefGoogle Scholar
  2. 2.
    Pera M et al (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92(3):151–159CrossRefGoogle Scholar
  3. 3.
    Siegel RL, Miller KD, Jemal A (2017) Cancer statistics. CA Cancer J Clin 67(1):7–30CrossRefGoogle Scholar
  4. 4.
    Pennathur A, Luketich JD (2008) Resection for esophageal cancer: strategies for optimal management. Ann Thorac Surg 85:S751–S756CrossRefGoogle Scholar
  5. 5.
    Wu PC et al (2003) The role of surgery in the management of oesophageal cancer. Lancet Oncol 4(8):481–488CrossRefGoogle Scholar
  6. 6.
    Atkins B et al (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78(4):1170–1176CrossRefGoogle Scholar
  7. 7.
    NCCN Clinical Practice Guidelines in Oncology (2013) Esophageal and esophagogastric junction cancersGoogle Scholar
  8. 8.
    Chang AC et al (2008) Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg 85(2):424–429CrossRefGoogle Scholar
  9. 9.
    Pennathur A, Awais O, Luketich JD (2010) Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 89(6):S2159–S2162CrossRefGoogle Scholar
  10. 10.
    DePaula AL et al (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5(1):1–5Google Scholar
  11. 11.
    Van den Broek WT et al (2004) Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus. Surg Endosc 18(5):812–817CrossRefGoogle Scholar
  12. 12.
    Cuschieri A (1994) Thoracoscopic subtotal oesophagectomy. Endosc Surg Allied Technol 2(1):21–25Google Scholar
  13. 13.
    Luketich JD et al (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238(4):486–494 discussion 494-5 Google Scholar
  14. 14.
    Santillan AA et al (2008) Minimally invasive surgery for esophageal cancer. J Natl Compr Canc Netw 6(9):879–884CrossRefGoogle Scholar
  15. 15.
    Verhage R et al (2009) Minimally invasive surgery for esophageal cancer. Minerva Chir 64(2):135–146Google Scholar
  16. 16.
    Safranek P et al (2010) Review of open and minimal access approaches to esophagectomy for cancer. Br J Surg 97(12):1845–1853CrossRefGoogle Scholar
  17. 17.
    Singh R et al (2011) Minimally invasive esophagectomy provides equivalent oncologic outcomes to open esophagectomy for locally advanced (stage II or III) esophageal carcinoma. Arch Surg 146(6):711–714CrossRefGoogle Scholar
  18. 18.
    Biere S et al (2012) Minimally invasive versus open esophagectomy for patients with esophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379(9829):1887–1892CrossRefGoogle Scholar
  19. 19.
    Hernandez JM et al (2013) Defining the learning curve for robotic-assisted esophagogastrectomy. J Gastrointest Surg 17(8):1346–1351CrossRefGoogle Scholar
  20. 20.
    Yamamoto M et al (2013) Minimally invasive surgery for esophageal cancer: review of the literature and institutional experience. Cancer Control 20(2):130–137CrossRefGoogle Scholar
  21. 21.
    Anderson C et al (2007) Robotic surgery for gastrointestinal malignancies. Int J Med Robot. 3(4):297–300CrossRefGoogle Scholar
  22. 22.
    Galvani C et al (2008) Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc 22(1):188–195CrossRefGoogle Scholar
  23. 23.
    Luketich JD et al (2012) Outcomes after minimally invasive esophagectomy. Ann Surg 256(1):95–103CrossRefGoogle Scholar
  24. 24.
    Orringer M et al (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 246(3):363–374CrossRefGoogle Scholar
  25. 25.
    Nguyen NT et al (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135(8):920–925CrossRefGoogle Scholar
  26. 26.
    Nguyen N et al (2008) Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg 248(6):1081–1091CrossRefGoogle Scholar
  27. 27.
    Metzger R et al (2004) High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Dis Esophagus 17:310–314CrossRefGoogle Scholar
  28. 28.
    Schlottmann F et al (2018) Esophageal cancer surgery: spontaneous centralization in the US contributed to reduce mortality without causing health disparities. Ann Surg Oncol 25(6):1580–1587CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kenneth Meredith
    • 1
    • 3
    • 5
    Email author
  • Paige Blinn
    • 1
  • Taylor Maramara
    • 1
  • Caitlin Takahashi
    • 2
  • Jamie Huston
    • 3
  • Ravi Shridhar
    • 4
  1. 1.Florida State University College of MedicineTallahasseeUSA
  2. 2.Naval Medical Center PortsmouthPortsmouthUSA
  3. 3.Sarasota Memorial Institute for Cancer CareSarasotaUSA
  4. 4.Florida Hospital Cancer InstituteOrlandoUSA
  5. 5.Gastrointestinal OncologySarasota Memorial Institute for Cancer CareSarasotaUSA

Personalised recommendations