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Kang CH, Yun TY, Park JH, Na B, Na KJ, Park S, Lee HJ, Park IK, Kim YT. Long-term survival analysis of robotic esophagectomy for esophageal cancer. Dis Esophagus 2024:doae054. [PMID: 38964872 DOI: 10.1093/dote/doae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/23/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
Robotic esophagectomy has improved early outcomes and enhanced the quality of lymphadenectomy for esophageal cancer surgery. This study aimed to determine risk factors for long-term survival following robotic esophagectomy and the causes of long-term mortality. We included patients who underwent robotic esophagectomy at our institute between 2010 and 2022. Robotic esophagectomy was defined as a surgical procedure performed robotically in both the abdomen and thorax. Robotic esophagectomy was performed in patients at all stages, including advanced stages, even in patients with stage IV and supraclavicular lymph node metastasis. A total of 340 patients underwent robotic esophagectomy during the study period. Ivor-Lewis operation and McKeown operation were performed on 153 (45.0%) and 187 (55.0%) patients, respectively. The five-year survival rates based on clinical stages were as follows: 85.2% in stage I, 62.0% in stage II, 54.5% in stage III, and 40.3% in stage IV. Risk factors for long-term survival included body mass index, Charlson comorbidity index, clinical stages, and postoperative complications of grade 4 or higher. Among the cases of long-term mortality, recurrence accounted for 42 patients (61.7%), while non-cancer-related death occurred in 26 patients (38.2%). The most common cause of non-cancer-related death was malnutrition and poor general condition, observed in 11 patients (16.2%). Robotic esophagectomy has demonstrated the ability to achieve acceptable long-term survival rates, even in patients with cervical lymph node metastasis. However, addressing high-grade postoperative complications and long-term malnutrition remains crucial for further improving the long-term survival outcomes of patients with esophageal cancer.
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Affiliation(s)
- Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Yun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyeon Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bubse Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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2
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Watson J, Reddy RM. Robot-Assisted-Minimally Invasive-Transhiatal Esophagectomy (RAMI-THE). Surg Oncol Clin N Am 2024; 33:497-508. [PMID: 38789192 DOI: 10.1016/j.soc.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The authors review the development and steps of the robotic-assisted minimally invasive transhiatal esophagectomy. Key goals of the robot-assisted approach have been to address some of the concerns raised about the technical challenges with the traditional open transhiatal esophagectomy while keeping most of the steps consistent with the open approach.
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Affiliation(s)
- Joshua Watson
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Rishindra M Reddy
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA.
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3
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Patel NM, Patel PH, Yeung KTD, Monk D, Mohammadi B, Mughal M, Bhogal RH, Allum W, Abbassi-Ghadi N, Kumar S. Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes. Ann Surg Oncol 2024; 31:4281-4297. [PMID: 38480565 PMCID: PMC11164768 DOI: 10.1245/s10434-024-15148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Radical esophagectomy for resectable esophageal cancer is a major surgical intervention, associated with considerable postoperative morbidity. The introduction of robotic surgical platforms in esophagectomy may enhance advantages of minimally invasive surgery enabled by laparoscopy and thoracoscopy, including reduced postoperative pain and pulmonary complications. This systematic review aims to assess the clinical and oncological benefits of robot-assisted esophagectomy. METHODS A systematic literature search of the MEDLINE (PubMed), Embase and Cochrane databases was performed for studies published up to 1 August 2023. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols and was registered in the PROSPERO database (CRD42022370983). Clinical and oncological outcomes data were extracted following full-text review of eligible studies. RESULTS A total of 113 studies (n = 14,701 patients, n = 2455 female) were included. The majority of the studies were retrospective in nature (n = 89, 79%), and cohort studies were the most common type of study design (n = 88, 79%). The median number of patients per study was 54. Sixty-three studies reported using a robotic surgical platform for both the abdominal and thoracic phases of the procedure. The weighted mean incidence of postoperative pneumonia was 11%, anastomotic leak 10%, total length of hospitalisation 15.2 days, and a resection margin clear of the tumour was achieved in 95% of cases. CONCLUSIONS There are numerous reported advantages of robot-assisted surgery for resectable esophageal cancer. A correlation between procedural volume and improvements in outcomes with robotic esophagectomy has also been identified. Multicentre comparative clinical studies are essential to identify the true objective benefit on outcomes compared with conventional surgical approaches before robotic surgery is accepted as standard of practice.
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Affiliation(s)
- Nikhil Manish Patel
- Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK
- The Upper Gastrointestinal Surgical Oncology Research Group, The Institute of Cancer Research, London, UK
| | - Pranav Harshad Patel
- Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK
- The Upper Gastrointestinal Surgical Oncology Research Group, The Institute of Cancer Research, London, UK
| | - Kai Tai Derek Yeung
- Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Monk
- Department of Upper Gastrointestinal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic London Hospital, London, UK
| | - Borzoueh Mohammadi
- Department of Upper Gastrointestinal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic London Hospital, London, UK
| | - Muntzer Mughal
- Department of Upper Gastrointestinal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic London Hospital, London, UK
| | - Ricky Harminder Bhogal
- Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK
- The Upper Gastrointestinal Surgical Oncology Research Group, The Institute of Cancer Research, London, UK
| | - William Allum
- Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nima Abbassi-Ghadi
- Department of Upper GI Surgery, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
| | - Sacheen Kumar
- Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
- The Upper Gastrointestinal Surgical Oncology Research Group, The Institute of Cancer Research, London, UK.
- Department of Upper Gastrointestinal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic London Hospital, London, UK.
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4
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Daiko H, Oguma J, Ishiyama K, Kurita D, Kubo K, Kubo Y, Utsunomiya D, Igaue S, Nozaki R, Leng XF, Fujita T, Fujiwara H. 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. Surg Endosc 2024; 38:3590-3601. [PMID: 38755464 DOI: 10.1007/s00464-024-10872-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024]
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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Affiliation(s)
- Hiroyuki Daiko
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Junya Oguma
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koshiro Ishiyama
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Daisuke Kurita
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kentaro Kubo
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuto Kubo
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Daichi Utsunomiya
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shota Igaue
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ryoko Nozaki
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Xue-Feng Leng
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeo Fujita
- Esophageal Surgery Division, National Cancer Hospital East, Chiba, Japan
| | - Hisashi Fujiwara
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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5
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Hoelzen JP, Fortmann L, Roy D, Szardenings C, Holstein M, Eichelmann AK, Rijcken E, Frankauer BE, Barth P, Wardelmann E, Pascher A, Juratli MA. Robotic-assisted esophagectomy with total mesoesophageal excision enhances R0-resection in patients with esophageal cancer: A single-center experience. Surgery 2024:S0039-6060(24)00323-4. [PMID: 38944589 DOI: 10.1016/j.surg.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/19/2024] [Accepted: 05/13/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND The focus of this research is to examine the growing use of robotic-assisted minimally invasive esophagectomy. Specifically, it evaluates the immediate clinical and cancer-related results of combining robotic-assisted minimally invasive esophagectomy with a systematic approach to total mesoesophageal excision, as opposed to traditional open transthoracic esophagectomy methods that do not employ a structured total mesoesophageal excision protocol. METHODS A propensity score-matched analysis of 185 robotic-assisted minimally invasive esophagectomies and 223 open transthoracic esophagectomies after standardized Ivor Lewis esophagectomy was performed. After 1:1 nearest neighbor matching to account for confounding by covariates, outcomes of 181 robotic-assisted minimally invasive esophagectomy and 181 open transthoracic esophagectomy were compared. RESULTS The patient characteristics showed significant differences in the age distribution and in comorbidities such as coronary heart disease, arterial hypertension, and anticoagulant intake. The R0-resection rate of robotic-assisted minimally invasive esophagectomy (96.7%) was significantly higher than open transthoracic esophagectomy (89.0%, P = .004). Thirty-day mortality and hospital mortality showed no significant differences. Postoperative pneumonia rate after robotic-assisted minimally invasive esophagectomy (12.7%) was significantly reduced (open transthoracic esophagectomy 28.7%, P < .001). Robotic-assisted minimally invasive esophagectomy had a significantly shorter intensive care unit stay (P < .001) and shorter hospital stay (P < .001). CONCLUSION This single-center, retrospective study employing propensity score matching found that combining robotic-assisted minimally invasive esophagectomy with structured total mesoesophageal excision results in better short-term clinical and oncologic outcomes than open transthoracic esophagectomy. This finding is significant because the increased rate of R0 resection could indicate a higher likelihood of improved long-term survival. Additionally, enhanced overall postoperative recovery may contribute to better risk management in esophagectomy procedures.
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Affiliation(s)
- Jens P Hoelzen
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Lukas Fortmann
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Dhruvajyoti Roy
- Department of Breast Surgical Oncology, University Hospital of Texas, MD Anderson Cancer Center, Houston, TX
| | - Carsten Szardenings
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Martina Holstein
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Emile Rijcken
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Brooke E Frankauer
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Peter Barth
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Germany
| | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Germany
| | - Andreas Pascher
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany
| | - Mazen A Juratli
- Department of General, Visceral, and Transplant Surgery, University Hospital Muenster, University of Muenster, Germany.
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6
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Yang Y, Jiang C, Su Y, Pan J, Liu Z, Zhang H, Li Z. Occurrence and recovery of vocal cord paralysis after minimally invasive McKeown esophagectomy, risk factors, and clinical outcome. Surgery 2024:S0039-6060(24)00320-9. [PMID: 38890101 DOI: 10.1016/j.surg.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND This study aimed to observe the occurrence of recurrent laryngeal nerve injury after McKeown esophagectomy for esophageal squamous cell carcinoma, as well as its recovery and influencing factors within 7 months after surgery. METHODS From July 2020 to July 2021, among all patients who underwent minimally invasive McKeown esophagectomy, 90 patients who developed vocal cord paralysis after surgery were included in the study. These patients underwent endoscopic vocal cord function assessment every 1 to 2 months and continued until 7 months postoperatively. RESULTS Among all 388 patients undergoing esophagectomy, 23.2% (90/388) of patients suffered postoperative vocal cord paralysis. Left, right, and bilateral injuries were confirmed in 73 (81.1%), 12 (13.3%), and 5 patients (5.6%), respectively. With a median recovery time being 183 days, the cumulative overall recovery rate was 65.4% at 7 months, 68.6% for the left side, 55.6% for the right, and 20.0% for bilateral injuries. In multivariable analysis, cervical paraoesophageal lymph node dissection and conventional thoracoscopic-assisted esophagectomy were demonstrated to be independent risk factors associated with non-recovery of vocal cord paralysis. CONCLUSIONS After intensive endoscopic follow-up, a cumulative vocal cord paralysis recovery rate of 65.4% within 7 months was observed in patients after minimally invasive McKeown esophagectomy. Cervical paraoesophageal lymph node dissection and conventional thoracoscopic-assisted esophagectomy were demonstrated to be risk factors hindering vocal cord paralysis recovery.
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Affiliation(s)
- Yuxin Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yuchen Su
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Jie Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Hong Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, China.
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7
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Deboever N, Jones CM, Yamashita K, Ajani JA, Hofstetter WL. Advances in diagnosis and management of cancer of the esophagus. BMJ 2024; 385:e074962. [PMID: 38830686 DOI: 10.1136/bmj-2023-074962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Esophageal cancer is the seventh most common malignancy worldwide, with over 470 000 new cases diagnosed each year. Two distinct histological subtypes predominate, and should be considered biologically separate disease entities.1 These subtypes are esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Outcomes remain poor regardless of subtype, with most patients presenting with late stage disease.2 Novel strategies to improve early detection of the respective precursor lesions, squamous dysplasia, and Barrett's esophagus offer the potential to improve outcomes. The introduction of a limited number of biologic agents, as well as immune checkpoint inhibitors, is resulting in improvements in the systemic treatment of locally advanced and metastatic esophageal cancer. These developments, coupled with improvements in minimally invasive surgical and endoscopic treatment approaches, as well as adaptive and precision radiotherapy technologies, offer the potential to improve outcomes still further. This review summarizes the latest advances in the diagnosis and management of esophageal cancer, and the developments in understanding of the biology of this disease.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher M Jones
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kohei Yamashita
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
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8
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Yang Y, Jiang C, Liu Z, Zhu K, Yu B, Yuan C, Qi C, Li Z. Impact of operative time on textbook outcome after minimally invasive esophagectomy, a risk-adjusted analysis from a high-volume center. Surg Endosc 2024; 38:3195-3203. [PMID: 38632118 DOI: 10.1007/s00464-024-10834-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND We aimed to study the impact of operative time on textbook outcome (TO), especially postoperative complications and length of postoperative stay in minimally invasive esophagectomy. METHODS Patients undergoing esophagectomy for curative intent within a prospectively maintained database from 2016 to 2022 were retrieved. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with medical teams random effects. A restricted cubic spline (RCS) plotting was used to characterize correlation between operative time and the odds for achieving TO. RESULTS Data of 2210 patients were examined. Median operative time was 270 mins (interquartile range, 233-313) for all cases. Overall, 902 patients (40.8%) achieved TO. Among non-TO patients, 226 patients (10.2%) had a major complication (grade ≥ III), 433 patients (19.6%) stayed postoperatively longer than 14 days. Multivariable analysis revealed operative time was associated with higher odds of major complications (odds ratio 1.005, P < 0.001) and prolonged postoperative stay (≥ 14 days) (odds ratio 1.003, P = 0.006). The relationship between operative time and TO exhibited an inverse-U shape, with 298 mins identified as the tipping point for the highest odds of achieving TO. CONCLUSIONS Longer operative time displayed an adverse influence on postoperative morbidity and increased lengths of postoperative stay. In the present study, the TO displayed an inverse U-shaped correlation with operative time, with a significant peak at 298 mins. Potential factors contributing to prolonged operative time may potentiate targets for quality metrics and risk-adjustment process.
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Affiliation(s)
- Yuxin Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Kaiyuan Zhu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Boyao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Chang Yuan
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Cong Qi
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China.
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9
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Che W, Zhong J, Huang J, Chen H, Feng C, Xie Y, He H, Chen Y, Li C, Wu B, Ding W, Lin W. Minimally invasive esophagectomy with non-invasive ventilation by laryngeal mask-assisted anesthesia for esophageal squamous cell carcinoma: case report. Front Oncol 2024; 14:1344662. [PMID: 38800373 PMCID: PMC11116687 DOI: 10.3389/fonc.2024.1344662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
Minimally invasive esophagectomy for cancer surgery remains associated with significant morbidity and surgical complications across the globe. Non-intubation video-assisted thoracic surgery (NIVATS) has been successfully employed in lung resection in recent years, but there are few reported cases with regard to the safety and feasibility of this approach in radical esophagectomy for patients with esophageal cancers. We present 4 consecutive cases with esophageal squamous cell carcinoma (ESCC) who received minimally invasive McKeown's esophagectomy under non-intubation general anesthesia from November 2022 to April 2023. All these patients were aged from 55 to 75 years old and were pathologically diagnosed with ESCC. All procedures of McKeown's esophagectomy in these patients were completed with non-invasive ventilation by laryngeal mask-assisted anesthesia. Operation duration ranged from 185 to 395 minutes and the estimated blood loss ranged from 25 to 60 ml in these 4 cases. No severe hypoxia was observed and transient hypercapnia was resolved intraoperatively. None of them was converted to endotracheal intubation with mechanical ventilation or to thoracotomy. The number of retrieved lymph nodes in mediastinum were 21-27 and all patients received R0 surgery with pathological stage as T1bN0M0 to T3N2M0. There was no serious complication (Clavien-Dindo grade III-IV) observed perioperatively and they were all discharged 11-14 days after the surgery with resumption of oral feeding. They are all alive without tumor recurrence at the date of data collection. The safety and efficacy of minimally invasive esophagectomy with non-invasive ventilation by laryngeal mask-assisted anesthesia for patients with ESCC are warranted for explored in a larger cohort study.
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Affiliation(s)
- Weibi Che
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Jian Zhong
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Jiawei Huang
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Huilong Chen
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Caihou Feng
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Yujie Xie
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Haiquan He
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Ying Chen
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Cui Li
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Bomeng Wu
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Wei Ding
- Department of Anesthesiology, Gaozhou People’s Hospital, Guangdong, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
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10
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Yu B, Liu Z, Zhang L, Pan J, Jiang C, Li C, Li Z. Pre- and intra-operative risk factors predict postoperative respiratory failure after minimally invasive oesophagectomy. Eur J Cardiothorac Surg 2024; 65:ezae107. [PMID: 38492559 DOI: 10.1093/ejcts/ezae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/01/2023] [Accepted: 03/14/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVES Severe pulmonary complications such as postoperative respiratory failure can occur after minimally invasive oesophagectomy. However, the risk factors have not been well identified. The goal of this study was to develop a predictive model for the occurrence of postoperative respiratory failure with a large sample. METHODS We collected data from patients with oesophageal cancer who had a minimally invasive oesophagectomy at Shanghai Chest Hospital from 2019 to 2022. Univariable and backward stepwise logistic regression analysis of 19 pre- and intra-operative factors was used before model fitting, and its performance was evaluated with the receiver operating characteristic curve. Internal validation was assessed with a calibration plot, decision curve analysis and area under the curve with 95% confidence intervals, obtained from 1000 resamples set by the bootstrap method. RESULTS This study enrolled 2,386 patients, 57 (2.4%) of whom developed postoperative respiratory failure. Backward stepwise logistic regression analysis revealed that age, body mass index, cardiovascular disease, diabetes, diffusion capacity of the lungs for carbon monoxide, tumour location and duration of chest surgery ≥101.5 min were predictive factors. A predictive model was constructed and showed acceptable performance (area under the curve: 0.755). The internal validation with the bootstrap method proves the good agreement for prediction and reality. CONCLUSIONS Obesity, severe diffusion dysfunction and upper segment oesophageal cancer were strong predictive factors. The established predictive model has acceptable predictive validity for postoperative respiratory failure after minimally invasive oesophagectomy, which may improve the identification of high-risk patients and enable health-care professionals to perform risk assessment for postoperative respiratory failure at the initial consultation.
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Affiliation(s)
- Boyao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Long Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunguang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Sakurai T, Hoshino A, Miyoshi K, Yamada E, Enomoto M, Mazaki J, Kuwabara H, Iwasaki K, Ota Y, Tachibana S, Hayashi Y, Ishizaki T, Nagakawa Y. Long-term outcomes of robot-assisted versus minimally invasive esophagectomy in patients with thoracic esophageal cancer: a propensity score-matched study. World J Surg Oncol 2024; 22:80. [PMID: 38504312 PMCID: PMC10953063 DOI: 10.1186/s12957-024-03358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Recently, robot-assisted minimally invasive esophagectomy (RAMIE) has gained popularity worldwide. Some studies have compared the long-term results of RAMIE and minimally invasive esophagectomy (MIE). However, there are no reports on the long-term outcomes of RAMIE in Japan. This study compared the long-term outcomes of RAMIE and MIE. METHODS This retrospective study included 86 patients with thoracic esophageal cancer who underwent RAMIE or MIE at our hospital from June 2010 to December 2016. Propensity score matching (PSM) was employed, incorporating co-variables such as confounders or risk factors derived from the literature and clinical practice. These variables included age, sex, body mass index, alcohol consumption, smoking history, American Society of Anesthesiologists stage, comorbidities, tumor location, histology, clinical TNM stage, and preoperative therapy. The primary endpoint was 5-year overall survival (OS), and the secondary endpoints were 5-year disease-free survival (DFS) and recurrence rates. RESULTS Before PSM, the RAMIE group had a longer operation time (min) than the MIE group (P = 0.019). RAMIE also exhibited significantly lower blood loss volume (mL) (P < 0.001) and fewer three-field lymph node dissections (P = 0.028). Postoperative complications (Clavien-Dindo: CD ≥ 2) were significantly lower in the RAMIE group (P = 0.04), and postoperative hospital stay was significantly shorter than the MIE group (P < 0.001). After PSM, the RAMIE and MIE groups consisted of 26 patients each. Blood loss volume was significantly smaller (P = 0.012), postoperative complications (Clavien-Dindo ≥ 2) were significantly lower (P = 0.021), and postoperative hospital stay was significantly shorter (P < 0.001) in the RAMIE group than those in the MIE group. The median observation period was 63 months. The 5-year OS rates were 73.1% and 80.8% in the RAMIE and MIE groups, respectively (P = 0.360); the 5-year DFS rates were 76.9% and 76.9% in the RAMIE and MIE groups, respectively (P = 0.749). Six of 26 patients (23.1%) in each group experienced recurrence, with a median recurrence period of 41.5 months in the RAMIE group and 22.5 months in the MIE group. CONCLUSIONS Compared with MIE, RAMIE led to no differences in long-term results, suggesting that RAMIE is a comparable technique.
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Affiliation(s)
- Toru Sakurai
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Akihiro Hoshino
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kenta Miyoshi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Erika Yamada
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masaya Enomoto
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Junichi Mazaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hiroshi Kuwabara
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kenichi Iwasaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshihiro Ota
- Department of Digestive Surgery, Kohsei Chuo General Hospital, 1-11-7 Mita, Meguro-ku, Tokyo, 153-8581, Japan
| | - Shingo Tachibana
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Hon-chou, Toda, Saitama, 335-0023, Japan
| | - Yutaka Hayashi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tetsuo Ishizaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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12
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Perry R, Barbosa JP, Perry I, Barbosa J. Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients. J Robot Surg 2024; 18:125. [PMID: 38492067 PMCID: PMC10944433 DOI: 10.1007/s11701-024-01880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
The role of robotic surgery in the curative-intent treatment of esophageal cancer patients is yet to be defined. To compare short-term outcomes between conventional minimally invasive (cMIE) and robot-assisted minimally invasive esophagectomy (RAMIE) in esophageal cancer patients. PubMed, Web of Science and Cochrane Library were systematically searched. The included studies compared short-term outcomes between cMIE and RAMIE. Individual risk of bias was calculated using the MINORS and RoB2 scales. There were no statistically significant differences between RAMIE and cMIE regarding conversion to open procedure, mean number of harvested lymph nodes in the mediastinum, abdomen and along the right recurrent laryngeal nerve (RLN), 30- and 90-day mortality rates, chyle leakage, RLN palsy as well as cardiac and infectious complication rates. Estimated blood loss (MD - 71.78 mL, p < 0.00001), total number of harvested lymph nodes (MD 2.18 nodes, p < 0.0001) and along the left RLN (MD 0.73 nodes, p = 0.03), pulmonary complications (RR 0.70, p = 0.001) and length of hospital stay (MD - 3.03 days, p < 0.0001) are outcomes that favored RAMIE. A significantly shorter operating time (MD 29.01 min, p = 0.004) and a lower rate of anastomotic leakage (RR 1.23, p = 0.0005) were seen in cMIE. RAMIE has indicated to be a safe and feasible alternative to cMIE, with a tendency towards superiority in blood loss, lymph node yield, pulmonary complications and length of hospital stay. There was significant heterogeneity among studies for some of the outcomes measured. Further studies are necessary to confirm these results and overcome current limitations.
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Affiliation(s)
- Rui Perry
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - José Pedro Barbosa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Stomatology, São João University Hospital Center, Porto, Portugal
| | - Isabel Perry
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - José Barbosa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of General Surgery, São João University Hospital Center, Porto, Portugal
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13
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May-Miller P, Markar SR, Blencowe N, Gossage JA, Botros A, Pucher PH. Opinion, uptake and current practice of robot-assisted upper gastrointestinal and oesophagogastric surgery in the UK: AUGIS national survey results. Ann R Coll Surg Engl 2024. [PMID: 38445600 DOI: 10.1308/rcsann.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION The uptake of upper gastrointestinal (GI) robotic surgery in the United Kingdom (UK), and Europe more widely, is expanding rapidly. This study aims to present a current snapshot of the practice and opinions of the upper GI community with reference to robotic surgery, with an emphasis on tertiary cancer (oesophagogastric) resection centres. METHODS An electronic survey was circulated to the UK upper GI surgical community via national mailing lists, social media and at an open-invitation conference on robotic upper GI surgery in January 2023. The survey included questions on surgeons' current practice or planned adoption (if any) of robotics at individual and unit level, and their opinions on robotic upper GI surgery in general. Priority ranking and Likert-scale response options were used. RESULTS In total, 81 respondents from 43 hospitals were included. Thirty-four resectional centres responded, including 30 of 31 (97%) recognised upper GI cancer centres in England. Respondents reported performing robotic surgery in 21 of 34 (61.8%) resectional centres, with a median of 65 procedures per centre performed at the time of the survey (range 0-500, interquartile range 93.75). Every centre without a robotic programme expressed a desire or had active plans to implement one. Respondents ranked surgeon ergonomics as the most important reason for pursuing robotics, followed by improvements in patient outcomes and oncological efficacy. CONCLUSIONS Robotic upper GI practice is nascent but rapidly growing in the UK with plans for uptake in almost all tertiary centres. There is growing opinion that this is likely to become the predominant surgical approach in future with benefits to both patients and surgeons. This snapshot offers a point of reference to all stakeholders in upper GI surgery.
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Affiliation(s)
| | - S R Markar
- Oxford University Hospitals NHS Foundation Trust, UK
| | | | - J A Gossage
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - A Botros
- Portsmouth Hospitals University NHS Trust, UK
| | - P H Pucher
- Portsmouth Hospitals University NHS Trust, UK
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14
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Dohrn N, Burgdorf SK, de Heer P, Klein MF, Jensen KK. The current application and evidence for robotic approach in abdominal surgery: A narrative literature review. Scand J Surg 2024; 113:21-27. [PMID: 38497506 DOI: 10.1177/14574969241232737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The current application of robotic surgery is evolving at a high pace in the current years. The technical advantages enable several abdominal surgical procedures to be performed minimally invasive instead of open surgery. Furthermore, procedures previously performed successfully using standard laparoscopy are now performed with a robotic approach, with conflicting results. The present narrative review reports the current literature on the robotic surgical procedures typically performed in a typical Scandinavian surgical department: colorectal, hernia, hepato-biliary, and esophagogastric surgery.
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Affiliation(s)
- Niclas Dohrn
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Blegdamsvej 9,2100 København Ø, Denmark
| | | | - Pieter de Heer
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital-Herlev & Gentofte, Herlev, Denmark
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15
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Grössmann-Waniek N, Riegelnegg M, Gassner L, Wild C. Robot-assisted surgery in thoracic and visceral indications: an updated systematic review. Surg Endosc 2024; 38:1139-1150. [PMID: 38307958 PMCID: PMC10881599 DOI: 10.1007/s00464-023-10670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery. METHODS We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and the risk of bias was evaluated using the Cochrane Collaboration's Tool Version 1. RESULTS For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications-recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting. CONCLUSION In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient low-quality evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should also take into account the limited quality of evidence, financial implications, and environmental factors. Furthermore, considerations should extend to the ergonomic aspects for maintaining a healthy surgical environment.
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Affiliation(s)
- Nicole Grössmann-Waniek
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Michaela Riegelnegg
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Lucia Gassner
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
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16
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Farrow H, Pickering OJ, Gossage JA, Pucher PH. Impact of thoracic duct resection during radical esophagectomy on oncological and survival outcomes: Systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107271. [PMID: 37979459 DOI: 10.1016/j.ejso.2023.107271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/14/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
Practice is variable in the inclusion or exclusion of the thoracic duct (TD) as part of the resected specimen and associated lymphadenectomy in radical esophagectomy for esophageal cancer. While some surgeons believe that the removal of TD-associated nodes may improve radicality and survival, others suggest this represents systemic disease and resection may increase morbidity without survival benefit. A systematic review was performed up to March 2023 using the search terms 'esoph∗' AND 'thoracic duct' for relevant articles which compared thoracic duct preservation (TDP) to resection (TDR) in esophagectomy for esophageal cancer. Included studies were required to report relevant oncological outcomes including at least one of overall survival (OS), disease free survival (DFS) and nodal yield. Seven cohort studies were included in data synthesis, including data for 5926 patients. None of the reported studies were randomised controlled trials. All studies originated from Japan or South Korea with almost exclusively squamous cell-type cancer. Nodal yield was higher in TDR groups. TDR was equivalent or inferior to TDP with reference to clinical outcomes (length of stay, morbidity, mortality). A single study reported increased OS in the TDR group while the remaining studies reported no significant difference. Overall study quality was moderate to poor. While an increased nodal yield may be associated with TDR, this may also be associated with higher morbidity, and currently available data does not suggest any survival benefit.
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Affiliation(s)
- Harry Farrow
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK
| | - Oliver J Pickering
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James A Gossage
- Department of Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Philip H Pucher
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK; Division of Surgery, Imperial College London, London, UK; Department of Pharmacology and Biosciences, University of Portsmouth, Portsmouth, UK.
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17
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Hays SB, Corvino G, Lorié BD, McMichael WV, Mehdi SA, Rieser C, Rojas AE, Hogg ME. Prince and princesses: The current status of robotic surgery in surgical oncology. J Surg Oncol 2024; 129:164-182. [PMID: 38031870 DOI: 10.1002/jso.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.
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Affiliation(s)
- Sarah B Hays
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Gaetano Corvino
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin D Lorié
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William V McMichael
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Syed A Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Caroline Rieser
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram E Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
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18
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Xu X, Xiong J, Xu Z, Hu Z, Alai G, Yu L, Xia S, Lin Y. Short-term outcomes of enhanced recovery after surgery protocol in robotic-assisted McKeown esophagectomy for esophageal cancer: a single-center retrospective cohort study. Front Oncol 2023; 13:1150945. [PMID: 38156111 PMCID: PMC10752759 DOI: 10.3389/fonc.2023.1150945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/24/2023] [Indexed: 12/30/2023] Open
Abstract
Background This study aimed to evaluate the short-term outcomes of enhanced recovery after surgery (ERAS) protocol in perioperative robotic-assisted McKeown esophagectomy (RAME) among esophageal cancer patients. Methods For this retrospective study, all patients who had undergone RAME with esophageal cancer using ERAS protocol and conventional management strategy at the surgery center of our hospital from February 2019 to March 2022 were performed for analysis. Results A total of 211 patients were included. Compared to the conventional group, the ERAS group has shorter median operative time [207 (147.5-267.5) vs. 244 (183-305), P<0.001], time to first flatus (P<0.001), time to out-of-bed activity (P=0.045), and time to liquid diet (P<0.001). In addition, the ERAS group has lower postoperative pain scores (3.62 ± 0.87 vs. 4.54 ± 0.91), shorter duration of analgesia pump [2 (1-3) vs. 3 (2.5-5.5)], shorter postoperative hospital stay [(9 (6-47) vs. 11 (6-79)], shorter postoperative hospital stay within neoadjuvant treated patients [8 (7-43) vs. 13 (8-67], shorter postoperative ICU stay [1 (0-7) vs. 2 (0-15)], and less reoperation rate (7.6% vs. 16.8%). Furthermore, the overall complication rate was significantly lower in the ERAS group (26.1%) than in the conventional group (50.4%). Notably, the ERAS group had lower thoracic fluid drainage volume than the conventional group on postoperative 2-7 days (P<0.05). Conclusions The application of ERAS protocol in esophageal cancer patients treated with RAME showed advantages of quick postoperative recovery in contrast to the conventional management strategy.
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Affiliation(s)
- Xia Xu
- Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jiajun Xiong
- Department of Thoracic Surgery, Jiujiang First People’s Hospital, Jiujiang, China
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Zhijie Xu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Zhi Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Guha Alai
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Lulu Yu
- Health Management Center, Jiujiang First People’s Hospital, Jiujiang, China
| | - Shaofeng Xia
- Department of Thoracic Surgery, Jiujiang First People’s Hospital, Jiujiang, China
| | - Yidan Lin
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
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19
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Hong Z, Cui B, Wang K, Bai X, Yang N, Zhang Y, Wu X, Cheng T, Jin D, Zhao J, Gou Y. Comparison of Clinical Efficacy Between Da Vinci Robot-Assisted Ivor Lewis Esophagectomy and McKeown Esophagectomy for Middle and Lower Thoracic Esophageal Cancer: A Multicenter Propensity Score-Matched Study. Ann Surg Oncol 2023; 30:8271-8277. [PMID: 37698668 DOI: 10.1245/s10434-023-14208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND We compared the perioperative efficacy and safety of da Vinci robot-assisted Ivor Lewis esophagectomy and McKeown esophagectomy for middle and lower thoracic esophageal cancer. METHODS A retrospective case-control study method was used. A total of 181 patients with esophageal cancer admitted to three medical centers in China from February 2018 to October 2022 were collected and divided into two groups according to surgical method: da Vinci robot-assisted thoracic surgery (RATS) Ivor Lewis esophagectomy (Ivor Lewis group) and RATS McKeown esophagectomy (McKeown group), respectively. Propensity score matching (PSM) analysis was used to reduce selection bias caused by confounding factors. The perioperative indicators of the two groups were compared and analyzed. RESULTS There was a statistically significant difference in age and tumor location between the Ivor Lewis group and the McKeown group. After PSM, the above factors were no longer statistically significant. There were 80 patients in each group after PSM. In terms of operative time (P = 0.005), anastomotic leakage (P = 0.029), and pulmonary infection (P = 0.035), the Ivor Lewis group has significant advantages; in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (P = 0.010), the McKeown group has significant advantages. CONCLUSION Both RATS Ivor Lewis esophagectomy and McKeown esophagectomy are safe and effective for treatment of middle and lower thoracic esophageal cancer. Ivor Lewis has advantages in operative time, anastomotic leakage, and pulmonary infection, while McKeown has advantage in lymph node dissection around the recurrent laryngeal nerve.
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Affiliation(s)
- Ziqiang Hong
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Baiqiang Cui
- Department of Thoracic Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Kai Wang
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xiangdou Bai
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Ning Yang
- Department of Thoracic Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Yu Zhang
- Department of Thoracic Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Xusheng Wu
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tao Cheng
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jing Zhao
- Lanzhou First People's Hospital, Lanzhou, China.
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
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20
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Kulasegaran S, Wang Y, Woodhouse B, MacCormick A, Srinivasa S, Koea J. Quality Performance Indicators for the Surgical Management of Oesophageal Cancer: A Systematic Literature Review. World J Surg 2023; 47:3262-3269. [PMID: 37865917 PMCID: PMC10694097 DOI: 10.1007/s00268-023-07216-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The objective of this systematic review was to identify pre-existing quality performance indicators (QPIs) for the surgical management of oesophageal cancer (OC). These QPIs can be used to objectively measure and compare the performance of individual units and capture key elements of patient care to improve patient outcomes. METHODS A systematic literature search of PubMed, MEDLINE, Scopus and Embase was conducted. Articles reporting on the quality of healthcare in relation to oesophageal neoplasm or cancer and the surgical treatment of OC available until the 1st of March 2022 were included. RESULTS The final list of articles included retrospective reviews (n = 13), prospective reviews (n = 8), expert guidelines (n = 1) and consensus (n = 1). The final list of QPIs was categorized as process, outcome or structural measures. Process measures included multidisciplinary involvement, availability of multimodality diagnostic and treatment pathways and surgical metrics. Outcome measures included reoperation and readmission rates, the achievement of RO resection and length of hospital stay. Structural measures include multidisciplinary meetings. CONCLUSIONS This systematic review summarizes QPIs for the surgical treatment of OC. The data will serve as an introduction to establishing a quality initiative project for OC resections.
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Affiliation(s)
| | - Yijiao Wang
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Braden Woodhouse
- Department of Oncology, The University of Auckland, Auckland, New Zealand
| | - Andrew MacCormick
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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21
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Kimura Y, Oki E, Nakanoko T, Hu Q, Natsugoe K, Nanbara S, Nakanishi R, Nakashima Y, Ota M, Yoshizumi T. Evolution of Treatment Outcomes and Prognostic Factors in Esophageal Cancer Surgery: A Retrospective Analysis of 1500 Consecutive Esophagostomies. ANNALS OF SURGERY OPEN 2023; 4:e347. [PMID: 38144504 PMCID: PMC10735088 DOI: 10.1097/as9.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/17/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To clarify the surgical outcomes of esophagectomy in Japan and comprehensively evaluate trends over time. It is important to analyze data from a large number of consecutive patients from a single institution. Methods We evaluated the treatment outcomes, complications, and prognosis of 1500 consecutive patients who underwent esophagectomy during 5 periods: group A (n = 284), 1964-1984; group B (n = 345), 1985-1993; group C (n = 253), 1994-2002; group D (n = 297), 2003-2012; and group E (n = 321), 2013-March 2020. Results The incidences of squamous cell carcinoma and adenocarcinoma were 93.8% and 3.3%, respectively. The proportion of adenocarcinoma cases has gradually increased over time. The in-hospital mortality rates for groups A, B, C, D, and E were 12%, 4.6%, 1.2%, 2.9%, and 1.5%, respectively. Group A had a significantly higher mortality rate than the other groups (P < 0.0001). Three-year survival rates were 22.2%, 47.8%, 53.4%, 69.9%, and 72.6% in groups A-E, respectively, 5-year survival rates were 17.2%, 41.3%, 49.2%, 63.9%, and 68.4%, respectively (P < 0.0001, group A vs groups D and E). The prognosis improved over time. Multivariate analysis revealed that depth of invasion, lymph node metastasis, the extent of lymph node resection, curative resection, pulmonary complications, and anastomotic leakage were significant independent prognostic factors. However, for recent surgeries (groups D and E), only the depth of invasion, lymph node metastasis, and curative resection were significant independent prognostic factors. Conclusions Valuable changes in background and prognostic factors occurred over time. These findings will help optimize esophageal cancer management and improve patient outcomes.
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Affiliation(s)
- Yasue Kimura
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomonori Nakanoko
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Qingjiang Hu
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Natsugoe
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Nanbara
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryota Nakanishi
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Nakashima
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuhiko Ota
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Brunner M, ElGendy A, Denz A, Weber G, Grützmann R, Krautz C. [Robot-assisted visceral surgery in Germany : Analysis of the current status and trends of the last 5 years using data from the StuDoQ|Robotics registry]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:940-947. [PMID: 37500803 PMCID: PMC10587021 DOI: 10.1007/s00104-023-01940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Robot-assisted systems have been increasingly used in general surgery for several years. Accordingly, the number of systems installed in Germany has also rapidly increased. While around 100 robot-assisted systems were used in German hospitals in 2018, this figure had already risen to more than 200 by 2022. The aim of this article is to present the current state of development and trends in robotic surgery in Germany. For this purpose, data from the StuDoQ|Robotics register were analyzed. Furthermore, a descriptive analysis of concomitant diagnosis-related groups (DRG) data was carried out via the Federal Statistical Office (Destatis), for a better assessment of the representativeness of the StuDoQ|Robotics register data. In both data sets, the annual number of robot-assisted visceral surgery procedures in Germany steadily increased. Compared to the DRG data, only 3.7% up to a maximum of 36.7% of all robot-assisted procedures performed were documented in the StuDoQ|Robotics register, depending on the type of procedure. Colorectal resections were the most frequent robot-assisted procedures (StuDoQ: 32.5% and 36.7% vs. DRG data: 24.2% and 29.7%) and had, for example, low mortality rates (StuDoQ: 1% and 1% vs. DRG data: 2.3% and 1.3%). Due to the low coverage rates of robot-assisted esophageal, gastric, pancreatic and liver interventions, no valid statements could be derived from the StuDoQ data for these areas. With the current coverage rates, the informative value of the StuDoQ|Robotics register is considerably limited for some types of intervention. In the future, measures should therefore be explored that lead to a significant increase in the coverage rates.
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Affiliation(s)
- Maximilian Brunner
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
| | - Amr ElGendy
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Axel Denz
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Georg Weber
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Robert Grützmann
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Christian Krautz
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
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23
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Nakauchi M, Shibasaki S, Suzuki K, Serizawa A, Akimoto S, Tanaka T, Inaba K, Uyama I, Suda K. Robotic esophagectomy with outermost layer-oriented dissection for esophageal cancer: technical aspects and a retrospective review of a single-institution database. Surg Endosc 2023; 37:8879-8891. [PMID: 37770607 DOI: 10.1007/s00464-023-10437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Systematic lymph node dissection in patients with gastric cancer could be sufficiently and reproducibly achieved along the outermost layer of the autonomic nerves and similar concept has been extensively used for robotic esophagectomy (RE) since 2018. This study aimed to determine the surgical and oncological safety of RE using the outermost layer-oriented approach for esophageal cancer (EC). METHODS Sixty-six patients who underwent RE with total mediastinal lymphadenectomy for primary EC between April 2018 and December 2021 were retrospectively reviewed. All underwent the outermost layer-oriented approach with intraoperative nerve monitoring (IONM). Postoperative complications within 30 days were analyzed. RESULTS Among the patients, 51 (77.3%) were male. The median age was 64 years, and the body mass index was 21.8 kg/m2. Furthermore, 58 (87.9%) patients had squamous cell carcinoma and eight (12.1%) patients had adenocarcinoma. Clinical stages I, II, and III were seen in 23 (34.8%), 23 (34.8%), and 16 (24.2%) patients, respectively. Thirty-four (51.5%) patients received preoperative treatment. No patient shifted to conventional thoracoscopic or open procedure intraoperatively. The median operative time was 716 min with 119 mL of blood loss. Additionally, 64 (97%) patients underwent R0 resection. The morbidity rates based on Clavien-Dindo grades ≥ II and ≥ IIIa were 30.3% and 10.6%, respectively, within 30 postoperative days. None died within 90 days postoperatively. Three (4.5%) patients exhibited recurrent laryngeal nerve (RLN) palsy (CD grade ≥ II). The sensitivity and specificity of IONM for RLN palsy were 50% and 98.3% at the right RLN and 33.3% and 98.0% at the left RLN, respectively. CONCLUSION RE with the outermost layer-oriented approach can provide safe short-term outcomes.
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Affiliation(s)
- Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazumitsu Suzuki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Akiko Serizawa
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shingo Akimoto
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan.
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24
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Meng YQ, Li B, Wang C, Jiang P, Song TN, Feng HM, Lin JP. Short-term outcomes of robot-assisted versus thoracoscopic-assisted Mckeown esophagectomy. Int J Med Robot 2023; 19:e2538. [PMID: 37218370 DOI: 10.1002/rcs.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Thoracoscopic-assisted and robot-assisted Mckeown esophagectomy are currently two common surgical methods, but there is no clear statement on the advantages and disadvantages of the two. METHODS This study conducted a single-centre retrospective analysis of esophageal cancer patients diagnosed and treated at Lanzhou University Second Hospital from 1 February 2020 to 31 July 2022. According to the inclusion and exclusion criteria, 126 patients were finally included in the RAM group and 169 patients in the TAM group. RESULTS There was no significant difference between the RAM and TAM groups in the number of lymph node dissections, operative time, the length of stay in the intensive care unit after surgery, the incidence of hoarseness, postoperative pulmonary complications, surgery-related complications, use of opioids after surgery, the length of postoperative hospital stay, and 30-day mortality. CONCLUSIONS RAM is a minimally invasive alternative to TAM and has similar short-term oncological efficacy.
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Affiliation(s)
- Yu-Qi Meng
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
| | - Cheng Wang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
| | - Peng Jiang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
| | - Tie-Niu Song
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
| | - Hai-Ming Feng
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
| | - Jun-Ping Lin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, Gansu, China
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25
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Yang Y, Li B, Xu X, Liu Z, Jiang C, Wu X, Yang Y, Li Z. Short-term and long-term effects of recurrent laryngeal nerve injury after robotic esophagectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107009. [PMID: 37562152 DOI: 10.1016/j.ejso.2023.107009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Robot-assisted minimally invasive esophagectomy (RAMIE) was reported to have superiority in upper mediastinal lymph nodes dissection than traditional approach, but related injuries to recurrent laryngeal nerve (RLNI) cannot be avoided. Considering that there is no study centering on RLNI during robotic manipulation, this study aimed to investigate the impact of RLNI on the short-term and long-term outcomes after RAMIE. METHODS Patients with esophageal cancer (EC) who underwent RAMIE from June 2015 to July 2019 were collated from a prospectively maintained database. Short-term and long-term outcomes of RLNI were analyzed. RESULTS A total of 409 patients were included with the incidence of RLNI being 18.6% (76/409). A higher rate of postoperative pulmonary complications including pneumonia (P < 0.001) and acute respiratory distress syndrome (ARDS) (P = 0.041) was associated with RLNI, requiring more interventions for bronchoscopy airway suction (P < 0.001), tracheal reintubation (P = 0.013) and tracheostomy (P < 0.001). Patients with RLNI had a prolonged length of hospitalization and intensive care unit (ICU) stay (P < 0.001). With the median follow-up time of 48.7 (interquartile range [IQR]:27.6-60.9) months, recurrence in regional lymph nodes at mediastinum did not differ between groups (P = 0.351). Similarly, the Kaplan-Meier curves revealed no significant divergency for overall survival after RLNI (P = 0.452). CONCLUSIONS RLNI after robotic esophagectomy is a serious morbidity associated with an increased rate of pulmonary complications, prolonged length of hospitalization with limited influence on long-term prognosis.
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Affiliation(s)
- Yuxin Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolu Wu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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26
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Hoelzen JP, Frankauer BE, Szardenings C, Roy D, Pollmann L, Fortmann L, Merten J, Rijcken E, Juratli MA, Pascher A. Reducing the Risks of Esophagectomies: A Retrospective Comparison of Hybrid versus Full-Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE) Approaches. J Clin Med 2023; 12:5823. [PMID: 37762765 PMCID: PMC10531670 DOI: 10.3390/jcm12185823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
This retrospective analysis aimed to assess and compare the short-term perioperative outcomes and morbidity of hybrid and full-Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE) surgical techniques. A total of 168 robotic-assisted Ivor Lewis esophagectomy procedures performed at Muenster University Hospital were included in the study, with 63 cases in the hybrid group and 105 cases in the full-robotic group. Demographic factors, comorbidities, and tumor stages showed no significant differences between the two groups. However, the full-RAMIE technique demonstrated superiority in terms of overall operative time, postoperative pain levels, and patient morphine consumption. Additionally, the full-RAMIE group exhibited better perioperative outcomes, with significantly shorter ICU stays and fewer occurrences of pneumonias and severe complications. While there was a trend favoring the full-RAMIE technique in terms of severe postoperative complications and anastomotic insufficiencies, further research is required to establish it as the gold standard surgical technique for Ivor Lewis esophagectomy.
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Affiliation(s)
- Jens Peter Hoelzen
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Brooke E. Frankauer
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Carsten Szardenings
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Dhruvajyoti Roy
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lukas Pollmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Lukas Fortmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Jennifer Merten
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Emile Rijcken
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Mazen A. Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (B.E.F.); (A.P.)
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27
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Kawka M, Fong Y, Gall TMH. Laparoscopic versus robotic abdominal and pelvic surgery: a systematic review of randomised controlled trials. Surg Endosc 2023; 37:6672-6681. [PMID: 37442833 PMCID: PMC10462573 DOI: 10.1007/s00464-023-10275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The current evidence is inconclusive on whether robotic or laparoscopic surgery is the optimal platform for minimally invasive surgery. Existing comparisons techniques focus on short-term outcomes only, while potentially being confounded by a lack of standardisation in robotic procedures. There is a pertinent need for an up-to-date comparison between minimally invasive surgical techniques. We aimed to systematically review randomised controlled trials comparing robotic and laparoscopic techniques in major surgery. METHODS Embase, Medline and Cochrane Library were searched from their inception to 13th September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic techniques in abdominal and pelvic surgery. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Short-term, health-related quality of life, and long-term, outcomes were analysed. RESULTS Forty-five studies, across thirteen procedures, involving 7364 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In majority of studies, there was no significant difference in complication rate (n = 31/35, 85.6%), length of postoperative stay (n = 27/32, 84.4%), and conversion rate (n = 15/18, 83.3%). Laparoscopic surgery was associated with shorter operative time (n = 16/31, 51.6%) and lower total cost (n = 11/13, 84.6%). Twenty three studies reported on quality of life outcomes; majority (n = 14/23, 60.9%) found no significant differences. CONCLUSION There were no significant differences between robotic surgery and laparoscopic surgery with regards to mortality and morbidity outcomes in the majority of studies. Robotic surgery was frequently associated with longer operative times and higher overall cost. Selected studies found potential benefits in post-operative recovery time, and patient-reported outcomes; however, these were not consistent across procedures and trials, with most studies being underpowered to detect differences in secondary outcomes. Future research should focus on assessing quality of life, and long-term outcomes to further elucidate where the robotic platform could lead to patient benefits, as the technology evolves.
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Affiliation(s)
- Michal Kawka
- Department of Medicine, Imperial College London, London, UK
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA, 91010, USA
| | - Tamara M H Gall
- Department of HPB Surgery, The Mater Misericordiae Hospital, Dublin, Ireland.
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28
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Peters AK, Juratli MA, Roy D, Merten J, Fortmann L, Pascher A, Hoelzen JP. Factors Influencing Postoperative Complications Following Minimally Invasive Ivor Lewis Esophagectomy: A Retrospective Cohort Study. J Clin Med 2023; 12:5688. [PMID: 37685756 PMCID: PMC10488704 DOI: 10.3390/jcm12175688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Complications arising following minimally invasive Ivor Lewis esophagectomy often result from inadequate enteral nutrition, highlighting the need for proactive measures to prevent such issues. One approach involves identifying high-risk cases prone to complications and implementing percutaneous endoscopic jejunostomy (PEJ) tube placement during esophageal resection to ensure timely enteral nutrition. METHODS In this single-center, retrospective cohort study, we examined patients who underwent minimally invasive esophagectomy for esophageal cancer at a high-volume center. The dataset encompassed demographic information, comorbidities, laboratory parameters, and intraoperative details. Our center utilized the EndoVac system pre-emptively to safeguard the anastomosis from harmful secretions and to enhance local oxygen partial pressure. All patients received pre-emptive EndoVac therapy and underwent esophagogastroduodenoscopy in the early postoperative days. The need for multiple postoperative EndoVac cycles indicated complications, including anastomotic insufficiency and subsequent requirement for a PEJ. The primary objectives were identifying predictive factors for anastomotic insufficiency and the need for multi-cycle EndoVac therapy, quantifying their effects, and assessing the likelihood of postoperative complications. RESULTS 149 patients who underwent minimally invasive or hybrid Ivor Lewis esophagectomy were analyzed and 21 perioperative and demographic features were evaluated. Postoperative complications were associated with the body mass index (BMI) category, the use of blood pressure medication, and surgery duration. Anastomotic insufficiency as a specific complication was correlated with BMI and the Charlson comorbidity index. The odds ratio of being in the high-risk group significantly increased with higher BMI (OR = 1.074, p = 0.048) and longer surgery duration (OR = 1.005, p = 0.004). CONCLUSIONS Based on our findings, high BMI and longer surgery duration are potential risk factors for postoperative complications following minimally invasive esophagectomy. Identifying such factors can aid in pre-emptively addressing nutritional challenges and reducing the incidence of complications in high-risk patients.
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Affiliation(s)
- Antje K. Peters
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Mazen A. Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Dhruvajyoti Roy
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer Merten
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Lukas Fortmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Jens Peter Hoelzen
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
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29
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Watanabe M, Kuriyama K, Terayama M, Okamura A, Kanamori J, Imamura Y. Robotic-Assisted Esophagectomy: Current Situation and Future Perspectives. Ann Thorac Cardiovasc Surg 2023; 29:168-176. [PMID: 37225478 PMCID: PMC10466119 DOI: 10.5761/atcs.ra.23-00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023] Open
Abstract
Robotic-assisted minimally invasive esophagectomy (RAMIE) has been rapidly spreading worldwide as a novel minimally invasive approach for esophageal cancer. This narrative review aimed to elucidate the current situation and future perspectives of RAMIE for esophageal cancer. References were searched using PubMed and Embase for studies published up to 8 April 2023. Search terms included "esophagectomy" or "esophageal cancer" and "robot" or "robotic" or "robotic-assisted." There are several different uses for the robot in esophagectomy. Overall complications are equivalent or may be less in RAMIE than in open esophagectomy and conventional (thoracoscopic) minimally invasive esophagectomy. Several meta-analyses demonstrated the possibility of RAMIE in reducing pulmonary complications, although the equivalent incidence was observed in two randomized controlled trials. RAMIE may increase the number of dissected lymph nodes, especially in the left recurrent laryngeal nerve area. Long-term outcomes are comparable between the procedures, although further research is required. Further progress in robotic technology combined with artificial intelligence is expected.
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Affiliation(s)
- Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Kuriyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayoshi Terayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Ekeke CN, Kuiper GM, Luketich JD, Ruppert KM, Copelli SJ, Baker N, Levy RM, Awais O, Christie NA, Dhupar R, Pennathur A, Sarkaria IS. Comparison of robotic-assisted minimally invasive esophagectomy versus minimally invasive esophagectomy: A propensity-matched study from a single high-volume institution. J Thorac Cardiovasc Surg 2023; 166:374-382.e1. [PMID: 36732144 DOI: 10.1016/j.jtcvs.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Robotic-assisted minimally invasive esophagectomy accounts for a growing proportion of esophagectomies, potentially due to improved technical capabilities simplifying the challenging aspects of standard minimally invasive esophagectomy. However, there is limited evidence directly comparing both operations. The objective is to evaluate the short-term and long-term outcomes of robotic-assisted minimally invasive esophagectomy in comparison with the minimally invasive esophagectomy approach for patients with esophageal cancer over a 7-year period at a high-volume center. The primary end points of this study were overall survival and disease-free survival. Secondary end points included operation-specific morbidity, lymph node yield, readmission status, and in-hospital, 30-day, and 90-day mortality. METHODS Patients who underwent robotic-assisted minimally invasive esophagectomy or standard minimally invasive esophagectomy over a 7-year period were identified from a prospectively maintained database. Inclusion criteria were patients with stage I to III disease, operations performed past the learning curve, and no evidence of scleroderma or cirrhosis. A 1:3 propensity match (robotic-assisted minimally invasive esophagectomy:minimally invasive esophagectomy) for multiple clinical covariates was performed to identify the final study cohort. Perioperative outcomes were compared between the 2 operations. RESULTS A total of 734 patients undergoing minimally invasive esophagectomy (n = 630) or robotic-assisted minimally invasive esophagectomy (n = 104) for esophageal cancer were identified. After exclusions and matching, a total cohort of 246 patients undergoing robotic-assisted minimally invasive esophagectomy (n = 65) or minimally invasive esophagectomy (n = 181) were identified. There was no difference in overall survival (P = .69) or disease-free survival (P = .70). There were no significant differences in rates of major morbidity: pneumonia (17% vs 17%, P = .34), chylothorax (8% vs 9%, P = .95), recurrent laryngeal nerve injury (0% vs 1.5%, P = 1), anastomotic leak (5% vs 4%, P = .49), intraoperative complications (9% vs 8%, P = .73), or complete resection rates (99% vs 96%, P = .68). There was no difference in in-hospital (P = .89), 30-day (P = .66) or 90-day mortality (P = .73) between both cohorts. The robotic-assisted minimally invasive esophagectomy cohort yielded a higher median lymph node harvest in comparison with the minimally invasive esophagectomy cohort (32 vs 29, P = .02). CONCLUSIONS Robotic-assisted minimally invasive esophagectomy may improve lymphadenectomy in patients undergoing esophagectomy for cancer. Minimally invasive esophagectomy and robotic-assisted minimally invasive esophagectomy are otherwise associated with similar mortality, morbidity, and perioperative outcomes. Further prospective study is required to investigate whether improved lymph node resection may translate to improved oncologic outcomes.
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Affiliation(s)
- Chigozirim N Ekeke
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Gino M Kuiper
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Kristine M Ruppert
- Epidemiology Data Center, The University of Pittsburgh School of Public Health, Pittsburgh, Pa
| | - Susan J Copelli
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Nicholas Baker
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ryan M Levy
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Omar Awais
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Neil A Christie
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa; Surgical Services Division, Veteran's Affairs Pittsburgh Healthcare System, Pittsburgh, Pa
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa.
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31
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Zhang Y, Dong D, Cao Y, Huang M, Li J, Zhang J, Lin J, Sarkaria IS, Toni L, David R, He J, Li H. Robotic Versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer: A Meta-analysis. Ann Surg 2023; 278:39-50. [PMID: 36538615 DOI: 10.1097/sla.0000000000005782] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To give a comprehensive review of the literature comparing perioperative outcomes and long-term survival with robotic-assisted minimally invasive esophagectomy (RAMIE) versus minimally invasive esophagectomy (MIE) for esophageal cancer. BACKGROUND Curative minimally invasive surgical treatment for esophageal cancer includes RAMIE and conventional MIE. It remains controversial whether RAMIE is comparable to MIE. METHODS This review was registered at the International Prospective Register of Systematic Reviews (CRD42021260963). A systematic search of databases was conducted. Perioperative outcomes and long-term survival were analyzed and subgroup analysis was conducted. Cumulative meta-analysis was performed to track therapeutic effectiveness. RESULTS Eighteen studies were included and a total of 2932 patients (92.88% squamous cell carcinoma, 29.83% neoadjuvant therapy, and 38.93% stage III-IV), 1418 underwent RAMIE and 1514 underwent MIE, were analyzed. The number of total lymph nodes (LNs) [23.35 (95% CI: 21.41-25.29) vs 21.98 (95% CI: 20.31-23.65); mean difference (MD) = 1.18; 95% CI: 0.06-2.30; P =0.04], abdominal LNs [9.05 (95% CI: 8.16-9.94) vs 7.75 (95% CI: 6.62-8.88); MD = 1.04; 95% CI: 0.19-1.89; P =0.02] and LNs along the left recurrent laryngeal nerve [1.74 (95% CI: 1.04-2.43) vs 1.34 (95% CI: 0.32-2.35); MD = 0.22; 95% CI: 0.09-0.35; P <0.001] were significantly higher in the RAMIE group. RAMIE is associated with a lower incidence of pneumonia [9.61% (95% CI: 7.38%-11.84%) vs 14.74% (95% CI: 11.62%-18.15%); odds ratio = 0.73; 95% CI: 0.58-0.93; P =0.01]. Meanwhile, other perioperative outcomes, such as operative time, blood loss, length of hospital stay, 30/90-day mortality, and R0 resection, showed no significant difference between the two groups. Regarding long-term survival, the 3-year overall survival was similar in the two groups, whereas patients undergoing RAMIE had a higher rate of 3-year disease-free survival compared with the MIE group [77.98% (95% CI: 72.77%-82.43%) vs 70.65% (95% CI: 63.87%-77.00%); odds ratio = 1.42; 95% CI: 1.11-1.83; P =0.006]. A cumulative meta-analysis conducted for each outcome demonstrated relatively stable effects in the two groups. Analyses of each subgroup showed similar overall outcomes. CONCLUSIONS RAMIE is a safe and feasible alternative to MIE in the treatment of resectable esophageal cancer with comparable perioperative outcomes and seems to indicate a possible superiority in LNs dissection in the abdominal cavity, and LNs dissected along the left recurrent laryngeal nerve and 3-year disease-free survival in particular in esophageal squamous cell carcinoma. Further randomized studies are needed to better evaluate the long-term benefits of RAMIE compared with MIE.
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Affiliation(s)
- Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Dong
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqin Cao
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maosheng Huang
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston TX
| | - Jian Li
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahao Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lerut Toni
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Rice David
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Jung JO, de Groot EM, Kingma BF, Babic B, Ruurda JP, Grimminger PP, Hölzen JP, Chao YK, Haveman JW, van Det MJ, Rouanet P, Benedix F, Li H, Sarkaria I, van Berge Henegouwen MI, van Boxel GI, Chiu P, Egberts JH, Sallum R, Immanuel A, Turner P, Low DE, Hubka M, Perez D, Strignano P, Biebl M, Chaudry MA, Bruns CJ, van Hillegersberg R, Fuchs HF. Hybrid laparoscopic versus fully robot-assisted minimally invasive esophagectomy: an international propensity-score matched analysis of perioperative outcome. Surg Endosc 2023; 37:4466-4477. [PMID: 36808472 PMCID: PMC10234920 DOI: 10.1007/s00464-023-09911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Currently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE). METHODS This retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers. RESULTS After propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml, p = 0.6967), operational time (mean 430.3 min versus 417.7 min, p = 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%, p = 0.560), radical resection (R0) rate (95.6% versus 96.3%, p = 0.8526) and total lymph node yield (mean 30.4 versus 29.5, p = 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%, p = 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%, p < 0.001). The length of stay on intensive care unit (median 3 days versus 2 days, p = 0.0005) and in-hospital (median 15 days versus 12 days, p < 0.0001) were longer for the hybrid laparoscopic RAMIE group. CONCLUSIONS Hybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.
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Affiliation(s)
- Jin-On Jung
- Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Eline M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B Feike Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Benjamin Babic
- Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Jens P Hölzen
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Yin-Kai Chao
- Department of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou Taoyuan, Taoyuan, Taiwan
| | - Jan W Haveman
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT Hospital Almelo, Almelo, The Netherlands
| | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Frank Benedix
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Shanghai, Shanghai, China
| | - Inderpal Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | - Gijs I van Boxel
- Department of General Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Philip Chiu
- Department of Surgery at Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Rubens Sallum
- Department of Digestive Surgery, University of São Paulo, São Paulo, Brasil
| | - Arul Immanuel
- Department of Surgery, Royal Victoria Infirmary Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - Paul Turner
- Department of Oesophagogastric Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Donald E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center Seattle, Seattle, USA
| | - Michal Hubka
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center Seattle, Seattle, USA
| | - Daniel Perez
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg, Hamburg, Germany
| | - Paolo Strignano
- Department of General Surgery, Citta' della Salute e della Scienza Turin, Turin, Italy
| | - Matthias Biebl
- Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Asif Chaudry
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust London, London, UK
| | - Christiane J Bruns
- Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | | | - Hans F Fuchs
- Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
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Pickering OJ, van Boxel GI, Carter NC, Mercer SJ, Knight BC, Pucher PH. Learning curve for adoption of robot-assisted minimally invasive esophagectomy: a systematic review of oncological, clinical, and efficiency outcomes. Dis Esophagus 2023; 36:6961031. [PMID: 36572404 DOI: 10.1093/dote/doac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/25/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Robot-assisted minimally invasive esophagectomy (RAMIE) is gaining increasing popularity as an operative approach. Learning curves to achieve surgical competency in robotic-assisted techniques have shown significant variation in learning curve lengths and outcomes. This study aimed to summarize the current literature on learning curves for RAMIE. METHODS A systematic review was conducted in line with PRISMA guidelines. Electronic databases PubMed, MEDLINE, and Cochrane Library were searched, and articles reporting on learning curves in RAMIE were identified and scrutinized. Studies were eligible if they reported changes in operative outcomes over time, or learning curves, for surgeons newly adopting RAMIE. RESULTS Fifteen studies reporting on 1767 patients were included. Nine studies reported on surgeons with prior experience of robot-assisted surgery prior to adopting RAMIE, with only four studies outlining a specified RAMIE adoption pathway. Learning curves were most commonly analyzed using cumulative sum control chart (CUSUM) and were typically reported for lymph node yields and operative times, with significant variation in learning curve lengths (18-73 cases and 20-80 cases, respectively). Most studies reported adoption without significant impact on clinical outcomes such as anastomotic leak; significant learning curves were more likely in studies, which did not report a formal learning or adoption pathway. CONCLUSION Reported RAMIE adoption phases are variable, with some authors suggesting significant impact to patients. With robust training through formal programmes or proctorship, however, others report RAMIE adoption without impact on clinical outcomes. A formalized adoption curriculum appears critical to prevent adverse effects on operative efficiency and patient care.
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Affiliation(s)
- Oliver J Pickering
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gijs I van Boxel
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK
| | - Nick C Carter
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK
| | - Stuart J Mercer
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK
| | - Benjamin C Knight
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK
| | - Philip H Pucher
- Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK
- Department of Pharmacology and Biosciences, University of Portsmouth, Portsmouth, UK
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Zhu H, Ma X, Ye T, Wang H, Wang Z, Liu Q, Zhao K. Esophageal cancer in China: Practice and research in the new era. Int J Cancer 2023; 152:1741-1751. [PMID: 36151861 DOI: 10.1002/ijc.34301] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/12/2022]
Abstract
China, as the one of the largest developing countries in the world and with about one-fifth of the global population, is bearing an increasing burden on health from cancer. In the area of esophageal cancer (EC), China accounts for more than 50% of the global cases, with this disease being a particularly worse for those in disadvantaged populations. Along with China's socioeconomic condition, the epidemiology, diagnosis, therapeutics and research of EC have developed throughout the 21st century. In the current review, existing control measures for EC in China are outlined, including the incidence, mortality, screening, clinical diagnosis, multidisciplinary treatment and research landscape. EC in China are very different from those in some other parts of the world, especially in Western countries. Core measures that could contribute to the prevention of EC and improve clinical outcomes in patients of less developed countries and beyond are recommended. International cooperation among academia, government and industry is especially warranted in global EC control.
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Affiliation(s)
- Hongcheng Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao Ma
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ting Ye
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Honggang Wang
- Department of Gastroenterology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Zezhou Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qi Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kuaile Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Matsunaga T, Shishido Y, Saito H, Sakano Y, Makinoya M, Miyauchi W, Shimizu S, Miyatani K, Kono Y, Murakami Y, Hanaki T, Kihara K, Yamamoto M, Tokuyasu N, Takano S, Sakamoto T, Hasegawa T, Fujiwara Y. Impact of Robot-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Propensity Score-Matched Short-Term Analysis. Yonago Acta Med 2023; 66:239-245. [PMID: 37229374 PMCID: PMC10203643 DOI: 10.33160/yam.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023]
Abstract
Background We compared short-term clinical outcomes between robotic-assisted minimally invasive esophagectomy (RAMIE) and video-assisted thoracic esophagectomy (VATS-E) using propensity score-matched analysis. Methods We enrolled 114 patients with esophageal cancer who underwent esophagectomy at our institution from January 2013 to January 2022. Propensity score matching was performed to minimize selection bias between the RAMIE and VATS-E groups. Results After propensity score matching, 72 patients (RAMIE group, n = 36; VATS-E group, n = 36) were selected for analysis. No significant differences in clinical variables were observed between the two groups. The RAMIE group had a significantly longer thoracic operation time (313 ± 40 vs. 295 ± 35 min, P = 0.048), a higher number of right recurrent laryngeal nerve lymph nodes (4.2 ± 2.7 vs. 2.9 ± 1.9, P = 0.039), and a shorter postoperative hospital stay (23.2 ± 12.8 vs. 30.4 ± 18.6 days, P = 0.018) than the VATS-E group. The RAMIE group tended to have a lower rate of anastomotic leakage (13.9% vs. 30.6%) than the VATS-E group, although the difference was not statistically significant (P = 0.089). No significant differences were found in recurrent laryngeal nerve paralysis (11.1% vs. 13.9%, P = 0.722) or pneumonia (13.9% vs. 13.9%, P = 1.000) between the RAMIE group and the VATS-E group. Conclusion Although RAMIE for esophageal cancer requires a longer thoracic surgery time, it might be a feasible and safe alternative to VATS-E for treating esophageal cancer. Further analysis is needed to clarify the advantages of RAMIE over VATS-E, especially in terms of long-term surgical outcomes.
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Affiliation(s)
- Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hiroaki Saito
- Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori 680-8517, Japan
| | - Yu Sakano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masahiro Makinoya
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shota Shimizu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yusuke Kono
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuki Murakami
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Shah MA, Altorki N, Patel P, Harrison S, Bass A, Abrams JA. Improving outcomes in patients with oesophageal cancer. Nat Rev Clin Oncol 2023; 20:390-407. [PMID: 37085570 DOI: 10.1038/s41571-023-00757-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
The care of patients with oesophageal cancer or of individuals who have an elevated risk of oesophageal cancer has changed dramatically. The epidemiology of squamous cell and adenocarcinoma of the oesophagus has diverged over the past several decades, with a marked increase in incidence only for oesophageal adenocarcinoma. Only in the past decade, however, have molecular features that distinguish these two forms of the disease been identified. This advance has the potential to improve screening for oesophageal cancers through the development of novel minimally invasive diagnostic technologies predicated on cancer-specific genomic or epigenetic alterations. Surgical techniques have also evolved towards less invasive approaches associated with less morbidity, without compromising oncological outcomes. With improvements in multidisciplinary care, advances in radiotherapy and new tools to detect minimal residual disease, certain patients may no longer even require surgical tumour resection. However, perhaps the most anticipated advance in the treatment of patients with oesophageal cancer is the advent of immune-checkpoint inhibitors, which harness and enhance the host immune response against cancer. In this Review, we discuss all these advances in the management of oesophageal cancer, representing only the beginning of a transformation in our quest to improve patient outcomes.
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Affiliation(s)
- Manish A Shah
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Nasser Altorki
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Pretish Patel
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sebron Harrison
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Adam Bass
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Julian A Abrams
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Narendra A, Barbour A. Introducing robotic oesophagectomy into an Australian practice: an assessment of the early procedural outcomes and learning curve. ANZ J Surg 2023; 93:1300-1305. [PMID: 37043677 DOI: 10.1111/ans.18445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Robotic oesophagectomy (RAMIO) is a novel procedure in Australia and New Zealand. We aimed to report the early operative and clinical outcomes achieved during the introduction of RAMIO into the practice of a single Australian surgeon and benchmark these against outcomes of patients receiving conventional minimally invasive oesophagectomy (MIO) by the same surgeon. METHODS Data on all patients undergoing RAMIO, performed by a single high-volume Australian surgeon, were collected from a prospectively maintained database. Operative, clinical and surgical quality outcomes were benchmarked on a univariable basis against those of patients receiving MIO. Learning curves were computed using quadratic and linear regression of operating times on case-numbers and compared using Cox regression modelling. RESULTS 290 patients (237 MIO, 53 RAMIO (47% Ivor-Lewis, 53% McKeon oesophagectomy)) were included. Compared with MIO, the median thoracic operating time was 20 min longer for RAMIO (P = 0.03). Following RAMIO, there was less blood loss (P < 0.01) and a shorter length of stay (P < 0.01).There were no differences in morbidity and quality of surgery following RAMIO compared with MIO. There were no deaths following RAMIO. Having progressed from MIO, the operating times for RAMIO improved after 22 cases compared with MIO (110 cases) (HR 0.70 (0.51-0.93), P = 0.01). CONCLUSION With careful implementation, RAMIO may be safely performed within the Australian setting and is associated with a modest increase in procedure duration, but less blood loss and shorter length of stay compared with conventional MIO.
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Affiliation(s)
- Aaditya Narendra
- The Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Barbour
- The Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
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Duan X, Yue J, Shang X, Chen C, Ma Z, Chen Z, Zhang C, Jiang H. Learning Curve of Robot-Assisted Lymph Node Dissection of the Left Recurrent Laryngeal Nerve: A Retrospective Study of 417 Patients. Ann Surg Oncol 2023:10.1245/s10434-023-13430-6. [PMID: 37029262 DOI: 10.1245/s10434-023-13430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/12/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Left recurrent laryngeal nerve (no.106recL) lymph node dissection is a challenging procedure, and robotic-assisted minimally invasive esophagectomy (RAMIE) may have some advantages. This study aimed to determine the learning curve of no.106recL lymph node dissection. METHODS The data of 417 patients who underwent McKeown RAMIE between June 2017 and June 2022 were retrospectively analyzed. The lymph node harvest of no.106recL was used to determine the learning curve, and the cumulative sum (CUSUM) method was employed to obtain the inflection point. RESULTS A total of 404 patients (404/417, 96.9%) underwent robotic surgery. Based on the number of no.106recL lymph nodes harvested, the CUSUM learning curve was mapped and divided into three phases: phase I (1‒75 cases), phase II (76‒240 cases), and phase III (241‒404 cases). The median (IQR) number of no.106recL lymph node harvests were 1 (4), 3 (6,) and 4 (4) in each phase (p < 0.001). The lymph node dissection rate gradually increased from 62.7% in phase I to 82.9% in phase III (p = 0.001). The total and thoracic lymph node harvest gradually increased (p < 0.001), whereas operation time (p = 0.001) and blood loss gradually decreased (p < 0.001). Moreover, the incidence of total complication (p = 0.020) and recurrent laryngeal nerve injury (p = 0.001) significantly decreased, and the postoperative hospital stay gradually shortened (p < 0.001). CONCLUSION Robotic no.106recL lymph node dissection has some advantages for patients with esophageal cancer. In this study, perioperative and clinical outcomes were significantly improved over the learning curve. However, further prospective studies are required to confirm our results.
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Affiliation(s)
- Xiaofeng Duan
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
| | - Jie Yue
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Xiaobin Shang
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Chuangui Chen
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhao Ma
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Zuoyu Chen
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Chen Zhang
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Hongjing Jiang
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
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Weindelmayer J, De Pasqual CA, Turolo C, Gervasi MC, Sacco M, Bencivenga M, Giacopuzzi S. Robotic versus open Ivor–Lewis esophagectomy: A more accurate lymph node dissection without burdening the leak rate. J Surg Oncol 2023; 127:1109-1115. [PMID: 36971002 DOI: 10.1002/jso.27246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/24/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Robotic-assisted minimally invasive esophagectomy (RAMIE) combines the beneficial effects of minimally invasive surgery on postoperative complications, especially on pulmonary ones, with the safety of the anastomosis performed in open surgery. Moreover, RAMIE could allow a more accurate lymphadenectomy. METHODS We reviewed our database to identify all patients with adenocarcinoma of the esophagus treated by Ivor-Lewis esophagectomy in the period January 2014 to June 2022. Patients were divided according to the thoracic approach into RAMIE and open esophagectomy (OE) groups. We compared the groups for early surgical outcomes, 90-day mortality as well as R0 rate, and the number of lymph nodes harvested. RESULTS We identified 47 patients in RAMIE and 159 patients in the OE group. Baseline characteristics were comparable. Operative time was significantly longer for RAMIE procedures (p < 0.01); however, we did not observe the difference in overall (RAMIE 55.5% vs. OE 61%, p = 0.76) and severe complications rate (RAMIE 17% vs. OE 22.6%, p = 0.4). The anastomotic leak rate was 2.1% after RAMIE and 6.9% after OE (p = 0.56). We did not report the difference in 90-day mortality (RAMIE 2.1% vs. OE 1.9%, p = 0.65). In the RAMIE group, we observed a significantly higher number of thoracic lymph nodes harvested, with a median of 10 lymph nodes in the RAMIE group versus 8 in the OE group (p < 0.01). CONCLUSIONS In our experience, RAMIE has morbimortality rates comparable to OE. Moreover, it allows a more accurate thoracic lymphadenectomy which results in a higher thoracic lymph nodes retrieval rate.
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Affiliation(s)
- Jacopo Weindelmayer
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | | | - Cecilia Turolo
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Maria Clelia Gervasi
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Michele Sacco
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Maria Bencivenga
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy
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Turner KM, Delman AM, Johnson K, Patel SH, Wilson GC, Shah SA, Van Haren RM. Robotic-Assisted Minimally Invasive Esophagectomy: Postoperative Outcomes in a Nationwide Cohort. J Surg Res 2023; 283:152-160. [PMID: 36410231 DOI: 10.1016/j.jss.2022.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/24/2022] [Accepted: 09/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Robotic-assisted minimally invasive esophagectomy (RAMIE) in clinical trials has demonstrated improved outcomes compared to open esophagectomy (OE). However, outcomes after national implementation remain unknown. The aim of this study was to evaluate postoperative outcomes after RAMIE. METHODS Patients who underwent elective esophagectomy between 2016 and 2020 were identified from the American College of Surgeons-- National Surgical Quality Improvement Program esophageal targeted participant user files and categorized by operative approach, with patients who underwent hybrid procedures excluded. Outcomes were compared between OE and minimally invasive esophagectomy (MIE)/RAMIE, with subset analyses by minimally invasive operative approach. Primary outcomes included pulmonary complications, anastomotic leak requiring reintervention, all-cause morbidity, and 30-d mortality. RESULTS In total 2786 patients were included, of which 58.3% underwent OE, 33.2% underwent MIE, and 8.4% underwent RAMIE. In the entire cohort, Ivor Lewis esophagectomy was the most common technique (64.6%), followed by transhiatal (22.0%), and a McKeown technique (13.4%). Comparing OE and MIE/RAMIE, pulmonary complications (21.5% versus 16.1%, P < 0.01) and all-cause morbidity (40.9% versus 32.3%, P < 0.01) were both reduced in the MIE/RAMIE group. When directly comparing MIE to RAMIE, there was no difference in the rate of pulmonary complications, anastomotic leak, all-cause morbidity, and mortality. However, RAMIE was associated with decreased all-cause morbidity compared to OE (40.9% versus 33.3%, P = 0.03). CONCLUSIONS RAMIE was associated with decreased morbidity compared to OE, with similar outcomes to MIE. The national adoption of RAMIE in this select cohort appears safe.
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Affiliation(s)
- Kevin M Turner
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aaron M Delman
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keilan Johnson
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sameer H Patel
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory C Wilson
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shimul A Shah
- Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Department of Surgery, Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Till BM, Grenda TR, Okusanya OT, Evans III NR. Robotic Minimally Invasive Esophagectomy. Thorac Surg Clin 2023; 33:81-88. [DOI: 10.1016/j.thorsurg.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hompe ED, Furlow PW, Schumacher LY. Starting and Developing a Robotic Thoracic Surgery Program. Thorac Surg Clin 2023; 33:11-17. [DOI: 10.1016/j.thorsurg.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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de Groot EM, Goense L, Kingma BF, Haverkamp L, Ruurda JP, van Hillegersberg R. Trends in surgical techniques for the treatment of esophageal and gastroesophageal junction cancer: the 2022 update. Dis Esophagus 2023:6986355. [PMID: 36636763 DOI: 10.1093/dote/doac099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/18/2022] [Accepted: 11/28/2022] [Indexed: 01/14/2023]
Abstract
The aim of this study was to evaluate the current practice in surgical techniques for esophageal and gastroesophageal junction cancer surgery worldwide and to compare the results to the previous surveys in 2007 and 2014. An online survey was sent out among surgical members of the International Society for Diseases of the Esophagus, the World Organization for Specialized Studies on Disease of the Esophagus, the International Gastric Cancer Association, the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland and Dutch gastroesophageal surgeons via the network of the investigators. In total, 260 surgeons completed the survey representing 52 countries and 6 continents; Europe 56%, Oceania 14%, Asia 14%, South-America 9%, North-America 7%. Of the responding surgeons, 39% worked in a hospital that performed >51 esophagectomies per year. Total minimally invasive esophagectomy was the preferred technique (53%) followed by hybrid esophagectomy (26%) of which 7% consisted of a minimally invasive thoracic phase and 19% of a minimally invasive abdominal phase. Total open esophagectomy was preferred by 21% of the respondents. Total minimally invasive esophagectomy was significantly more often performed in high-volume centers compared with non-high-volume centers (P = 0.002). Robotic assistance was used in 13% during the thoracic phase and 6% during the abdominal phase. Minimally invasive transthoracic esophagectomy has become the preferred approach for esophagectomy. Although 21% of the surgeons prefer an open approach, 26% of the surgeons perform a hybrid procedure which may reflect further transition towards the use of total minimally invasive esophagectomy.
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Affiliation(s)
- E M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B F Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Haverkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Sun HB, Jiang D, Liu XB, Xing WQ, Liu SL, Chen PN, Li P, Ma YX. Perioperative Outcomes and Learning Curve of Robot-Assisted McKeown Esophagectomy. J Gastrointest Surg 2023; 27:17-26. [PMID: 36261780 DOI: 10.1007/s11605-022-05484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the perioperative outcomes of patients undergoing robot-assisted McKeown esophagectomy (RAME) and the learning curves of surgeons performing RAME at a single center. METHODS Perioperative outcomes of RAME and video-assisted McKeown esophagectomy (VAME) were compared after eliminating confounding factors by propensity score matching (PSM). The cumulative sum (CUSUM) method was used to evaluate the learning curves of RAME for a single surgical team. RESULTS In general, a total of 198 patients with esophageal cancer (RAME: 45 patients, VAME: 153 patients) were included in this study, and 43 pairs of patients receiving RAME or VAME were matched using 1:1 PSM analysis. Those in the RAME group had more lymph nodes dissected in the total lymph nodes (median 29.0 vs. 26.0, P = 0.011) and the upper mediastinum (median 8.0 vs. 6.0, P < 0.001), especially the left recurrent laryngeal nerve (RLN) lymph node (median 4.0 vs. 2.0, P = 0.001). According to the trend of the CUSUM plot, the learning curve was divided into two stages at the 20th RAME procedure. After mastering the learning curve, RAME harvested a significantly higher number of upper mediastinal lymph nodes (median 9.0 vs. 6.0, P = 0.001), left RLN lymph nodes (median 5.0 vs. 3.5, P = 0.003), and right RLN lymph nodes (median 4.0 vs. 2.0, P = 0.002). Meanwhile, the incidence of postoperative pneumonia in the proficiency phase was significantly lower than that in the learning phase (4.0% vs. 25.0%, P = 0.04). CONCLUSIONS RAME improved left RLN lymph node dissection. Surgeons with extensive VAME experience need at least 20 cases to achieve early proficiency in RAME.
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Affiliation(s)
- Hai-Bo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
| | - Duo Jiang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xian-Ben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wen-Qun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Shi-Lei Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Pei-Nan Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Peng Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Ya-Xing Ma
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
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Siddiqi A, Johnston FM. The Perioperative and Operative Management of Esophageal and Gastric Cancer. Surg Oncol Clin N Am 2023; 32:65-81. [PMID: 36410922 DOI: 10.1016/j.soc.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optimal management of esophageal and gastric cancer during the perioperative period requires a coordinated multidisciplinary treatment effort. Accurate staging guides treatment strategy. Advances in minimally invasive surgery and endoscopy have reduced risks associated with resection while maintaining oncological standards. Although the standard perioperative chemo-and radiotherapy regimens have not yet been established, randomized control trials exploring this subject show promising results.
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Affiliation(s)
- Amn Siddiqi
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Fabian M Johnston
- Division of Gastrointestinal Surgical Oncology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Rebecchi F, Ugliono E, Allaix ME, Morino M. Why pay more for robot in esophageal cancer surgery? Updates Surg 2023; 75:367-372. [PMID: 35953621 PMCID: PMC9852204 DOI: 10.1007/s13304-022-01351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023]
Abstract
Esophagectomy is the gold standard for the treatment of resectable esophageal cancer. Traditionally, it is performed through a laparotomy and a thoracotomy, and is associated with high rates of postoperative complications and mortality. The advent of robotic surgery has represented a technological evolution in the field of esophageal cancer treatment. Robot-assisted Minimally Invasive Esophagectomy (RAMIE) has been progressively widely adopted following the first reports on the safety and feasibility of this procedure in 2004. The robotic approach has better short-term postoperative outcomes than open esophagectomy, without jeopardizing oncologic radicality. The results of the comparison between RAMIE and conventional minimally invasive esophagectomy are less conclusive. This article will focus on the role of RAMIE in the current clinical scenario with particular attention to its possible benefits and perspectives.
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Affiliation(s)
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | | | - Mario Morino
- Department of Surgical Sciences, University of Turin, Torino, Italy
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[Robots in visceral and thoracic surgery-Quo vadis?]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 94:318-324. [PMID: 36580100 DOI: 10.1007/s00104-022-01787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
Robotic surgical systems are now an inherent part of the German hospital landscape. In recent years, there has been an enormous increase in installed systems and operations performed, especially in abdominal surgery. Even though there is a lack of studies with the highest grade of evidence, the advantages of the technique are obvious-particularly technically demanding operations can now be performed safely and less invasively for patients. Robotics are now being implemented in many non-university institutions. At the Israelite Hospital (Israelitisches Krankenhaus) Hamburg it could be demonstrated that with systematic and modular training, i.e. execution of certain surgical steps, it is possible to significantly flatten the learning curve while maintaining excellent oncological quality, postoperative morbidity and mortality. The costs to have a system up and running are the main limitations for the implementation of robotic surgery. The acquisition, material and maintenance costs are substantial so that the type of intervention and the training of prospective surgeons are limited by the costs. The robotic approach will fully unroll its disruptive character compared to laparoscopy once it is competitive not only qualitatively in the field of medical contents but also economically. In the future the ROBIN working group of the German Society for General and Visceral Surgery (DGAV) wants to create the basic prerequisites for valid studies by working with registers and could act as an independent central intermediary between hospitals and the industry to promote practical innovations and systematic training for surgeons.
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Marano A, Salomone S, Pellegrino L, Geretto P, Robella M, Borghi F. Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): surgical technique and early results. Updates Surg 2022:10.1007/s13304-022-01439-7. [PMID: 36510101 PMCID: PMC9744375 DOI: 10.1007/s13304-022-01439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Esophagectomy is the selected treatment for nonmetastatic esophageal and esophagogastric junction cancer, although high perioperative morbidity and mortality incur. Robot-assisted minimally invasive esophagectomy (RAMIE) effectively reduces cardiopulmonary complications compared to open esophagectomy and offers a technical advantage, especially for lymph node dissection and intrathoracic anastomosis. This article aims at describing our initial experience of Ivor Lewis RAMIE, focusing on the technique's main steps and robotic-sewn esophagogastrostomy. Prospectively collected data from all consecutive patients who underwent Ivor Lewis RAMIE for cancer was reviewed. Reconstruction was performed with a gastric conduit pull-up and a robotic-sewn intrathoracic anastomosis. Intraoperative and postoperative complications were recorded as prescribed by the Esophagectomy Complications Consensus Group (ECCG). Thirty patients underwent Ivor Lewis RAMIE with complete mediastinal lymph node dissection and robot-sewn anastomosis. No intraoperative complications nor conversion occurred. Pulmonary complications totaled 26.7%. Anastomotic leakage (ECCG, type III) and conduit necrosis (ECCG, type III) both occurred in one patient (3.3%). Chylothorax appeared in 2 patients (6.7%) (ECCG, Type IIA). Anastomotic stricture, successfully treated with endoscopic dilatations, occurred in 8 cases (26.7%). Median overall postoperative stay was 11 days (range, 6-51 days). 30 day and 90 day mortality was 0%. R0 resection was performed in 96.7% of patients with a median number of 47 retrieved lymph nodes. RAMIE with robot-sewn intrathoracic anastomosis appears to be feasible, safe and effective, with favorable perioperative results. Nevertheless, further high-quality studies are needed to define the best anastomotic technique for Ivor Lewis RAMIE.
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Affiliation(s)
- Alessandra Marano
- grid.413179.90000 0004 0486 1959Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Sara Salomone
- grid.413179.90000 0004 0486 1959Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Luca Pellegrino
- grid.419555.90000 0004 1759 7675Department of Oncologic Surgery, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov. 142, Km 3,95, Candiol, TO Italy
| | - Paolo Geretto
- grid.413179.90000 0004 0486 1959Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Manuela Robella
- grid.419555.90000 0004 1759 7675Department of Oncologic Surgery, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov. 142, Km 3,95, Candiol, TO Italy
| | - Felice Borghi
- grid.419555.90000 0004 1759 7675Department of Oncologic Surgery, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov. 142, Km 3,95, Candiol, TO Italy
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Triantafyllou T, van der Sluis P, Skipworth R, Wijnhoven BPL. The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes? Oncol Ther 2022; 10:337-349. [PMID: 35945401 PMCID: PMC9681954 DOI: 10.1007/s40487-022-00206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Esophagectomy is considered the cornerstone of the radical treatment of esophageal cancer. In the past decades, minimally invasive techniques including robot-assisted approaches have become popular. The aim of minimally invasive surgery is to reduce the surgical trauma, resulting in faster recovery, reduction in complications, and better quality of life after surgery. Secondly, a more precise dissection may lead to better oncological outcomes. As such, minimally invasive esophagectomy is now seen by many as the standard surgical approach. However, evidence supporting this viewpoint is limited. This narrative review summarizes recent prospectively designed studies on minimally invasive esophagectomy.
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Affiliation(s)
- Tania Triantafyllou
- Upper Gastrointestinal Surgical Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Pieter van der Sluis
- Upper Gastrointestinal Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Richard Skipworth
- Upper Gastrointestinal Surgical Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Bas P L Wijnhoven
- Upper Gastrointestinal Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Wang H. Network pharmacology- and molecular docking-based approaches to unveil the pharmacological mechanisms of dihydroartemisinin against esophageal carcinoma. Front Genet 2022; 13:1017520. [PMID: 36506308 PMCID: PMC9732420 DOI: 10.3389/fgene.2022.1017520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: Dihydroartemisinin (DHA) is an active metabolite of artemisinin and its derivatives, which is a potent drug extensively applied in clinical treatment of malaria. The antitumor properties of DHA have received increasing attention. However, there is no systematic summary on the pharmacological mechanisms of DHA against esophageal carcinoma (ESCA). The present study implemented network pharmacology- and molecular docking-based approaches to unveil the pharmacological mechanisms of DHA against ESCA. Methods: DHA targets were accessed through integrating the SwissTargetPrediction, HERB, as well as BATMAN-TCM platforms. In TCGA-ESCA dataset, genes with differential expression were screened between 161 ESCA and 11 normal tissue specimens. DHA targets against ESCA were obtained through intersection. Their biological significance was evaluated with functional enrichment analysis. A prognostic signature was established via uni- and multivariate cox regression analyses. DHA-target interactions were predicted via molecular docking. Molecular dynamics simulation was implemented to examine the stability of DHA binding to potential targets. Results: The study predicted 160 DHA targets as well as 821 genes with differential expression in ESCA. Afterwards, 16 DHA targets against ESCA were obtained, which remarkably correlated to cell cycle progression. The ADORA2B- and AURKA-based prognostic signature exhibited the reliability and independency in survival prediction. The stable docking of DHA-ADORA2B and DHA-AURKA was confirmed. Conclusion: Collectively, this study systematically revealed the basis and mechanism of DHA against ESCA through targeting multi-target and multi-pathway mechanisms, and thus offered theoretical and scientific basis for the clinical application of DHA.
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