Will robot-assisted minimally invasive esophagectomy improve patient outcomes compared to conventional minimally invasive esophagectomy?

Abstract

Aim: To determine if introducing a standardized minimally invasive esophagectomy (MIE) to robot-assisted MIE (RAMIE) improves the short-term patient outcomes.

Methods: A total of 292 patients with esophageal cancer underwent thoracic esophagectomy [MIE (n = 208); RAMIE (n = 84)] at Aichi Cancer Center Hospital between January 2019 and August 2022. The cumulative sum (CUSUM) method was used to analyze the learning curve for RAMIE. The MIE and RAMIE surgical and postoperative outcomes were also analyzed retrospectively. Propensity score matching was used to compensate for the selection bias.

Results: The CUSUM plot of the console time reached a plateau in the 29th case and began to decrease in the 43rd case. Therefore, we defined phase I (introductory phase) up to the 28th case, phase II from the 29th - 42nd case, and phase III from the 43rd case onward. The median thoracic operative time was significantly longer in the RAMIE group than the MIE group in phase I (P < 0.001); however, the median RAMIE console time was 227.5, 212, and 182 min in phases I-III, respectively, compared to a median MIE thoracic operative time of 232 min. The incidence of recurrent laryngeal nerve (RLN) palsy was significantly less after phase II for RAMIE (12.5%) compared to MIE (25%; P = 0.04). The incidence of RLN palsy was also decreased in phases II and III for RAMIE after matching (13%; P = 0.04).

Conclusion: Standardization of RAMIE may decrease the incidence of RLN palsy in patients compared to MIE.

Keywords

Robotic surgery / esophageal cancer / learning curve / recurrent laryngeal nerve palsy

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