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First year experience in minimally invasive robot-assisted esophagectomy in a large academic referral center
Stefano Bongiolatti1, Alessandro Gonfiotti1, Mario Annecchiarico2, Michele Di Marino2, Domenico Viggiano1, Benedetta Pesi2, Luca Voltolini1, Andrea Coratti2.
1Thoracic Surgery Unit, Florence, Italy, 2Division of Oncological and Robotic General Surgery, Florence, Italy.

OBJECTIVE: Radical trans-thoracic esophagectomy with en bloc lymphadenectomy is basilar in multimodal treatment with curative intent for cancer, but is associated with higher incidence of complications. Minimally invasive and robot-assisted esophagectomy are being used to reduce surgical trauma and morbidity.
The aim is to report our initial experience with robot-assisted minimally invasive esophagectomy, evaluating the feasibility, safety, and oncological adequacy.
METHODS: This is a retrospective study using a prospective database of 20 consecutive patients (16 men and 4 women, mean age 62,8 years) underwent sub-total (-robot-assisted Ivor-Lewis esophagectomy -RA-ILE-) or total esophagectomy (robot-assisted McKeown esophagectomy -RA-MKE-) for esophageal cancer from July 2014 to December 2015 at our Institution.
RESULTS: We performed 15 subtotal esophagectomy -RA-ILE- and 5 total esophagectomy -RA-MKE- without intra-operative complication and conversion. Median operative time was 553 minutes (including cart setting-up and positioning) and estimated blood loss was 100 ml. Median ICU stay was 1 day and median overall postoperative hospital stay was 10 days. In-hospital mortality rate was 5% (n=1), overall morbidity rate was 45% (n=9): pulmonary complication were observed in 2 patients (10%), gastric conduit ischemia in 1 (5%), symptomatic anastomotic leak in 2 (10%) and radiological leak in 1 (5%). Two clinical anastomotic leak were surgically treated whereas the others were managed conservatively. The majority of patient had T3 disease (7 patients 35%) and 45% had nodal involvement. All resections were radical (100% was R0) and median number of lymph nodes was 30.
CONCLUSIONS: This preliminary experience suggests that robotic-assisted trans-thoracic esophagectomy for malignant lesions is a real surgical option to conventional surgery with satisfying results in term of feasibility, safety, and oncological adequacy

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