Early Outcomes of Robot-Assisted Versus Thoracoscopic-Assisted Ivor Lewis Esophagectomy for Esophageal Cancer: A Propensity Score-Matched Study

• Published in: Annals of surgical oncology 2019-05, Vol.26 (5), p.1284-1291
• Main Authors: Zhang, Yajie, Han, Yu, Gan, Qinyi, Xiang, Jie, Jin, Runsen, Chen, Kai, Che, Jiaming, Hang, Junbiao, Li, Hecheng
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Cancer; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Demography; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagus; Female; Follow-Up Studies; Gastrointestinal surgery; Humans; Lymph nodes; Lymphatic system; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Ostomy; Postoperative Complications; Prognosis; Propensity Score; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - methods; Surgery; Surgical Oncology; Thoracic Oncology; Thoracoscopy - methods
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-019-07273-3

Background Both robot-assisted Ivor Lewis esophagectomy (RAILE) and conventional thoracoscopic-assisted Ivor Lewis esophagectomy (TAILE) are minimally invasive surgical techniques for the treatment of middle and distal esophageal cancer. However, no research studies comparing early outcomes between RAILE and TAILE have been reported. Methods A retrospective analysis was made of 184 patients, 76 in the RAILE group and 108 in the TAILE group, who underwent minimally invasive Ivor Lewis esophagectomy between December 2014 and June 2018. Propensity score-matched analysis was performed between the two groups based on demographics, comorbidities, American Society of Anesthesiologists score, tumor location, tumor size, and pathological stage. Perioperative outcomes were compared. Results Two conversions to thoracotomy occurred in the RAILE group. There was no 30-day in either group. Sixty-six matched pairs were identified for each group. Within the propensity score-matched cohorts, the operative time in the RAILE group was significantly longer than that in the TAILE group (302.0 ± 62.9 vs. 274.7 ± 38.0 min, P  = 0.004). There was no significant difference in the blood loss [200.0 ml (interquartile range [IQR], 100.0–262.5 ml) vs. 200.0 ml (150.0–245.0 ml), P  = 0.100], rates of overall complications (28.8 vs. 24.2%, P  = 0.554), length of stay [9.0 days (IQR 8.0–12.3 days) vs. 9.0 days (IQR 8.0–11.3 days), P  = 0.517], the number of total dissected lymph nodes (19.2 ± 9.2 vs. 19.3 ± 9.5, P  = 0.955), and detailed categories of lymph nodes. Conclusions RAILE demonstrated comparable early outcomes compared with TAILE and should be considered as an alternative minimally invasive option for treating esophageal cancer.