International Society For Minimally Invasive Cardiothoracic Surgery

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Mid-term Results Of Robot-assisted Esophagectomy For 206 Patients With Esophageal Squamous Cell Cancer Recurrence And Survival
Xiaobin Zhang, Zhigang Li, Bin Li, Bo Ye, Yifeng Sun, Xufeng Guo, Yu Yang, Rong Hua, Yi He, Teng Mao.
Shanghai Chest Hospital, Shanghai, China.

Background: Robot-assisted minimally invasive esophagectomy (RAMIE) is an emerging surgical approach for the treatment of esophageal cancer. However, long-term survival results and local tumor control ability of RAMIE are still not clear. The purpose of this study was to observe the effect of mediastinal lymph node dissection and mid-term recurrence pattern in robot-assisted esophageal cancer resection. Methods: We reviewed a retrospective collected database of patients with esophageal carcinoma undergoing RAMIE by one specific surgeon in our institution (November 2015-November 2017). Recurrent patterns were defined as local, regional and distant metastasis. Cumulative rates of disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) were analyzed by the Kaplan-Meier method. Results: A total of 206 patients with squamous cell esophageal cancer composed the study cohort, of whom, 15 (7.3%) patients received neoadjuvant therapy. The total surgical time was 252.8 58.7 mins and the thoracic surgical time was 89.5 28.7 mins. The median length of hospital stay was 11 days. The major complications were observed in 22 (10.7%) patients with pneumonia, 28 (13.6%) patients with anastomotic leakage and 55 (26.7%) patients with vocal cord palsy. The lymph nodes dissected in overall, mediastinal and para recurrent laryngeal nerve were 18.5 9.2, 12.0 6.5 and 4.4 3.3 respectively. Lymph nodes metastasis were found in 100 (48.5%) patients. No 30-day mortality was observed. The median follow-up period was 24 months (range: 12 to 36 months), 30 (14.6%) deaths were observed and esophageal cancer-specific deaths were found in 22 (10.7%) patients. Forty-three (20.9%) patients experienced recurrence and the median recurrent time was 9.7 months. Local recurrence, regional recurrence and distant metastasis were observed in 3 (1.5%), 18 (8.8%), and 31 (15.2%) patients and a total of 11 (5.3%) patients experienced mediastinal recurrence. The two-year DFS, OS and CSS rates were 72.4%, 83.2% and 87.1% respectively. Conclusions: Robot-assisted esophagectomy is a feasible and safe surgical approach for the treatment of esophageal cancer. Local recurrence at mediastinum can be reduced via robot-assisted radical lymph node dissection, although with higher incidence of recurrent laryngeal nerve injury.


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