Comparison Of Short-term Outcomes After Robot-assisted Esophagectomy And Thoracic-laparoscopic Minimally Invasive Esophagectmy
Xiaobin Zhang, Sr., Zhigang Li, Yu Yang, Yifeng Sun, Bo Ye, Xufeng Guo.
Shanghai Chest Hospital, Shanghai, China.
OBJECTIVE: This study aims to compare the short-term outcomes of robot-assisted esophagectomy (RAE) with conventional thoracoscopic-laparoscopic minimally invasive esophagectomy (CTLE) for resectable esophageal squamous cell carcinoma.
METHODS: Between November 2015 and September 2016, a series of 87 consecutive patients undergoing RAE and 136 undergoing CTLE at our institution received Mckeown esophagectomy with complete two-field thoracic and abdominal lymph node dissection. In order to exclude the influence of the learning curve, we excluded the initial 20 RAE. Retrospective analysis of the clinical data was performed on 116 patients using the 1:1 ratio propensity score matching method.
RESULTS: No significant difference was noted between the two groups in terms of age, gender, body mass index (BMI), tumor location, Charlson Comorbidity Index (CCI) or neoadjuvant therapy. Compared with the CTLE group, the RAE group was associated with similar total operative duration (260.67±50.24 vs 275.90±60.71 minutes, P=0.144) and thoracic operative duration (91.66±28.01 vs 95.55±34.25 minutes, P=0.504); significantly shorter median postoperative hospital stay (11 vs 13 days, P=0.042);increased total number of lymph nodes harvested (19.42±11.88 vs 15.91±9.09, P=0.078), and along the recurrent laryngeal nerve (RLN) (4.82±3.74 vs 2.83±2.15, P=0.001). The R0 resection rate (55, 95.6%) was the same in both groups. No surgical-related mortality was noted in either group. There were no significant differences between RAE and CTLE in the incidence of anastomotic leak (8, 13.8% vs 15, 25.9%, P=0.103), respiratory failure (2, 3.4% vs 4, 6.9%, P=0.402) or vocal cord palsy (10, 17.2% vs 7, 12.1%, P=0.431).
CONCLUSIONS: RAE is a safe and feasible alternative surgical treatment for resectable esophageal squamous cell carcinoma. Compared with CTLE, it has comparable surgical duration and morbidity but is associated with a greater yield of lymph nodes, especially along the recurrent laryngeal nerve.
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