Transhiatal robot-assisted minimally invasive esophagectomy: unclear benefits compared to traditional transhiatal esophagectomy

• Published in: Journal of robotic surgery 2022-08, Vol.16 (4), p.883-891
• Main Authors: Keeney-Bonthrone, Toby P., Abbott, Kenneth L., Haley, Caleb, Karmakar, Monita, Hawes, Armani M., Chang, Andrew C., Lin, Jules, Lynch, William R., Carrott, Philip W., Lagisetty, Kiran H., Orringer, Mark B., Reddy, Rishindra M.
• Format: Article
• Language: English
• Subjects: Abdomen; Cancer therapies; Dissection; Epidural; Esophageal cancer; Laparoscopy; Length of stay; Lymphatic system; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Mortality; Original Article; Ostomy; Patients; Robotics; Robots; Statistical analysis; Statistical significance; Surgeons; Surgery; Thrombosis; Urology; Variables
• ISSN: 1863-2491; 1863-2483; 1863-2491
• DOI: 10.1007/s11701-021-01311-7

Esophagectomy is a high-risk operation, regardless of technique. Minimally invasive transthoracic esophagectomy could reduce length of stay and pulmonary complications compared to traditional open approaches, but the benefits of minimally invasive transhiatal esophagectomy are unclear. We performed a retrospective review of prospectively gathered data for open transhiatal esophagectomies (THEs) and transhiatal robot-assisted minimally invasive esophagectomies (TH-RAMIEs) performed at a high-volume academic center between 2013 and 2017. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for outcomes. 465 patients met inclusion criteria (378 THE and 87 TH-RAMIE). THE patients more likely had an ASA score of 3 + (89.1% vs 77.0%, p  = 0.012), whereas TH-RAMIE patients more likely had a pathologic staging of 3+ (43.7% vs. 31.2%, p  = 0.026). TH-RAMIE patients were less likely to receive epidurals (aOR 0.06, 95% confidence interval [CI] 0.03–0.14, p