Universität zu Köln

Torabi, Saeed ORCID: 0000-0003-0646-0465, Omuro, Philipp ORCID: 0009-0000-4907-1852, Krauss, Dolores T., Stoll, Sandra E. ORCID: 0000-0002-4803-1362, Kammerer, Tobias ORCID: 0000-0001-8920-7187, Dieplinger, Georg, Schmidt, Thomas ORCID: 0000-0002-7166-3675, Dusse, Fabian ORCID: 0000-0001-7762-6966, Steinbicker, Andrea U. ORCID: 0000-0002-5237-961X, Bruns, Christiane J. ORCID: 0000-0001-6590-8181, Schiffmann, Lars M. ORCID: 0000-0002-2320-5004 and Fuchs, Hans F. ORCID: 0000-0003-4764-8050 (2025). Impact of preoperative diastolic dysfunction on short-term outcomes following robotic-assisted minimally invasive esophagectomy (RAMIE). Journal of Robotic Surgery, 19 (1). pp. 1-10. Springer Nature. ISSN 1863-2491

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Abstract

[Artikel-Nr. 442] Diastolic dysfunction is a common echocardiographic finding in patients undergoing major surgery and has been associated with adverse perioperative outcomes, particularly in high-risk procedures. However, its prognostic relevance in robotic-assisted minimally invasive esophagectomy (RAMIE) remains unclear. This study investigates the impact of preoperative diastolic dysfunction on short-term postoperative outcomes and intensive care unit (ICU) course in patients undergoing RAMIE. A retrospective, monocentric cohort of 256 adult patients, who underwent robotic-assisted Ivor-Lewis esophagectomy for esophageal carcinoma at the Medical Faculty of the University of Cologne and University Hospital of Cologne (2019–2024), was screened. Of these, 181 cases with available preoperative transthoracic echocardiography (TTE) data were included in this study. Included patients were stratified based on the presence and grade of diastolic dysfunction in preoperative echocardiography. Postoperative outcomes including new-onset atrial fibrillation (POAF), pulmonary complications, anastomotic leakage, length of ICU stay, and mortality, were analyzed using χ2 and Kruskal–Wallis tests, with * p < 0.05 considered significant. 181 of 256 screened patients could be included in our study. Preoperative diastolic dysfunction was identified in 67 of 181 screened patients: 63 patients with grade I and 4 patients with grade II diastolic dysfunction. Patients with diastolic dysfunction were more likely to present with coronary artery disease (13 vs. 7, 19 vs. 6%; p = 0.01), diabetes mellitus (16 vs. 10, 24 vs. 9%; p = 0.01), and hypertension (37 vs. 43, 55 vs. 38%; p = 0.02) compared to those without. However, no differences were observed in postoperative outcomes, including postoperative atrial fibrillation (21 vs. 18%; p > 0.05), pulmonary complications (22% in both groups; χ 2 = 0.045; p > 0.05), anastomotic leakage (16 vs. 18%; χ 2 = 0.048, p > 0.05), ICU stay (median 2 days for both groups), or in-hospital mortality (4 vs. 2%; p > 0.05). The severity of complications, as classified by the Clavien–Dindo system, was also not associated with diastolic dysfunction (Pearson chi-square: χ 2 = 1.094; p > 0.05). Mild diastolic dysfunction (predominantly grade I) was not associated with worse short-term outcomes in patients undergoing RAMIE. Despite a higher burden of cardiovascular comorbidities, ICU stay, postoperative complication rates, and mortality were comparable to patients with normal diastolic function. These findings suggest that mild diastolic dysfunction should not be considered a contraindication for RAMIE and highlight the need for refined risk stratification tools integrating echocardiographic and clinical parameter.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Torabi, Saeed UNSPECIFIED https://orcid.org/0000-0003-0646-0465 UNSPECIFIED Omuro, Philipp UNSPECIFIED https://orcid.org/0009-0000-4907-1852 UNSPECIFIED Krauss, Dolores T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoll, Sandra E. UNSPECIFIED https://orcid.org/0000-0002-4803-1362 UNSPECIFIED Kammerer, Tobias UNSPECIFIED https://orcid.org/0000-0001-8920-7187 UNSPECIFIED Dieplinger, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Thomas UNSPECIFIED https://orcid.org/0000-0002-7166-3675 UNSPECIFIED Dusse, Fabian UNSPECIFIED https://orcid.org/0000-0001-7762-6966 UNSPECIFIED Steinbicker, Andrea U. UNSPECIFIED https://orcid.org/0000-0002-5237-961X UNSPECIFIED Bruns, Christiane J. UNSPECIFIED https://orcid.org/0000-0001-6590-8181 UNSPECIFIED Schiffmann, Lars M. UNSPECIFIED https://orcid.org/0000-0002-2320-5004 UNSPECIFIED Fuchs, Hans F. UNSPECIFIED https://orcid.org/0000-0003-4764-8050 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-805567
Identification Number:	10.1007/s11701-025-02624-7
Journal or Publication Title:	Journal of Robotic Surgery
Volume:	19
Number:	1
Page Range:	pp. 1-10
Number of Pages:	10
Date:	1 August 2025
Publisher:	Springer Nature
ISSN:	1863-2491
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Anästhesiologie und Operative Intensivmedizin > Klinik für Anästhesiologie und Operative Intensivmedizin Faculty of Medicine > Chirurgie > Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Diastolic dysfunction ; Robotic-assisted minimally invasive esophagectomy (RAMIE) ; Postoperative outcomes ; Perioperative risk stratification ; Preoperative transthoracic echocardiography UNSPECIFIED
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80556