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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