Journal Article

Multicenter Experience in Robot-Assisted Minimally Invasive Esophagectomy — a Comparison of Hybrid and Totally Robot-Assisted Techniques

Perez, Daniel, Fuchs, Hans, Ghadban, Tarik, Biebl, Matthias, Egberts, Jan-Hendrik, Bruns, Christiane J., Becker, Thomas, Staubitz, Julia I., Izbicki, Jakob R., Reeh, Matthias, Scognamiglio, Pasquale, Grimminger, Peter P., Lang, Hauke

2021

Overview

Background Oncological esophageal surgery has evolved significantly in the last decades. From open esophagectomy over (hybrid) minimally invasive surgery, nowadays, robot-assisted minimally invasive esophagectomy (RAMIE) approaches are applied. Current techniques require an analysis of possible advantages and disadvantages indicating the direction towards a novel gold standard. Methods Robot-assisted Ivor Lewis esophagectomies, performed in the period from April 2017 to June 2019 in five German centers (Berlin, Cologne, Hamburg, Kiel, Mainz), were included in this study. Pre-, intra-, and postoperative parameters were assessed. Cases were grouped for hybrid (H-RAMIE) versus totally robot-assisted (T-RAMIE) approaches. Postoperative parameters and complications were compared using risk ratios. Results A total of 175 operations were performed as T-RAMIE and 67 as H-RAMIE. Patient age (median age 62 years) and sex (83.1% male) were similarly distributed in both groups. Median duration of esophagectomy was significantly lower in the T-RAMIE group (385 versus 427 min, p < 0.001). The risks of “overall morbidity” (32.0 versus 47.8%; risk ratio [RR], 95% confidence interval (CI): 1.5, 1.1–2.1; p = 0.026), “anastomotic leak” (10.3 versus 22.4%; RR, CI: 2.2, 1.2–4.1; p = 0.020), and “respiratory failure” (1.1 versus 7.5%; RR, CI: 6.5, 1.3–32.9; p = 0.019) were significantly higher in case of H-RAMIE. Conclusions In the five participating German centers, T-RAMIE was the preferred procedure (72.3% of operations). In comparison to H-RAMIE, T-RAMIE was associated with a significantly reduced risk of postoperative morbidity, anastomotic leak, and respiratory failure as well as a significantly reduced time necessary for esophagectomy.

• Publisher: Springer US,Springer Nature B.V
• Subject: Abdomen / Age / Body mass index / Comorbidity / Diaphragm (Anatomy) / Esophageal cancer / Esophageal Neoplasms - surgery / Esophagectomy - adverse effects / Female / Gastroenterology / Hospitals / Humans / Laparoscopy / Lymphatic system / Male / Medical prognosis / Medicine / Medicine & Public Health / Middle Aged / Minimally invasive surgery / Minimally Invasive Surgical Procedures / Morbidity / Original / Original Article / Patients / Pneumonia / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Respiratory failure / Robotic Surgical Procedures - adverse effects / Robotics / Robots / Surgery / Surgical outcomes / Thoracic surgery / Treatment Outcome / Veins & arteries