Universität zu Köln

Babic, Benjamin ORCID: 0000-0003-0313-6862, Muller, Dolores T., Jung, Jin-On, Schiffmann, Lars M., Grisar, Paula, Schmidt, Thomas, Chon, Seung-Hun ORCID: 0000-0002-8923-6428, Schroeder, Wolfgang, Bruns, Christiane J. and Fuchs, Hans F. (2022). Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center. Surg. Endosc., 36 (10). S. 7747 - 7756. NEW YORK: SPRINGER. ISSN 1432-2218

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Abstract

Introduction Transthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive esophagectomy (MIE), and most recently to robot-assisted minimally invasive esophagectomy (RAMIE), with each step demonstrating improved patient outcomes. Aim of this study with more than 600 patients is to complete a propensity-score matched comparison of postoperative short-term outcomes after highly standardized RAMIE vs. HE in a European high volume center. Patients and Methods Six hundred and eleven patients that underwent transthoracic Ivor-Lewis esophagectomy for esophageal cancer between May 2016 and May 2021 were included in the study. In January 2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and ICG (indocyanine green) for RAMIE cases. Data were retrospectively analyzed from a prospectively maintained IRB-approved database. Outcomes of patients undergoing standardized RAMIE from January 2019 to May 2021 were compared to our overall cohort from May 2016-April 2021 (HE) after a propensity-score matching analysis was performed. Results Six hundred and eleven patients were analyzed. 107 patients underwent RAMIE. Of these, a total of 76 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis (RAMIE group). A total of 535 patients underwent HE (Hybrid group). Seventy patients were propensity-score matched in each group and analysis revealed no statistically significant differences in baseline characteristics. RAMIE patients had a significantly shorter ICU stay (p = 0.0218). Significantly more patients had no postoperative complications (Clavien Dindo 0) in the RAMIE group [47.1% vs. 27.1% in the HE group (p = 0.0225)]. No difference was seen in lymph node yield and R0 resection rates. Anastomotic leakage rates when matched were 14.3% in the hybrid group vs. 4.3% in the RAMIE group (p = 0.07). Conclusion Our analysis confirms the safety and feasibility of RAMIE and HE in a large cohort after propensity score matching. A regular postoperative course (Clavien-Dindo 0) and a shorter ICU stay were seen significantly more often after RAMIE compared to HE. Furthermore it shows that both procedures provide excellent short-term oncologic outcomes, regarding lymph node harvest and R0 resection rates. A randomized controlled trial comparing RAMIE and HE is still pending and will hopefully contribute to ongoing discussions.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Babic, Benjamin UNSPECIFIED orcid.org/0000-0003-0313-6862 UNSPECIFIED Muller, Dolores T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jung, Jin-On UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiffmann, Lars M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Grisar, Paula UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Chon, Seung-Hun UNSPECIFIED orcid.org/0000-0002-8923-6428 UNSPECIFIED Schroeder, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, Christiane J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuchs, Hans F. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-662752
DOI:	10.1007/s00464-022-09254-2
Journal or Publication Title:	Surg. Endosc.
Volume:	36
Number:	10
Page Range:	S. 7747 - 7756
Date:	2022
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-2218
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANASTOMOTIC LEAK; CANCER; MORTALITY; EXPERIENCE; MANAGEMENT; SURGERY Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66275