274. ROBOTIC-ASSISTED THORACOSCOPIC ESOPHAGECTOMY WITH MEDIASTINAL LYMPH NODE DISSECTION: DOES IT FEASIBLE FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA SURGERY?

Abstract

Abstract Background Esophageal cancer is sixth leading cause of cancer-related mortality globally in 2020. Esophageal squamous cell carcinoma is one of most aggressive and need extensive operative treatment for radical and oncologic purpose. Conventional thoracotomy is highly invasive, conventional video-assisted is quite technical difficulty related with deep and narrow angle of exposure. Robotic-assisted procedure is new challenging to beat this limitation. This is descriptive report of initial robotic-assisted experiences regard to feasibility, safety and oncologic outcome. Methods We conducted a retrospective analysis of a single-center database from March 2012 to February 2023, including patients aged 45–85 years with resectable lesions of the esophageal squamous cell carcinoma who underwent robotic-assisted thoracoscopic esophagectomy using the Da Vinci Robotic surgery system. Patient data, surgical procedures, interventions, and early outcomes (within 30 days postoperation) were collected and analyzed to assess postoperative variables and adequacy of cancer clearance. The study included 12 patients, and the primary outcome was the incidence of pulmonary complications during the hospital stay. Results The overall incidence of postoperative pulmonary complications was 4cases (33.3%), with mild pulmonary infection occurring in 2cases (16.7%) without 30-day mortality in robotic-assisted thoracoscopic esophagectomy. The median admission period were 2 days and 15 days for ICU and hospital stay, respectively. The median time for the thoracic phase of operation was 210 minutes (150-445 minutes), and the median blood loss volume was 55 mL (20–300 mL). Pathological results showed that overall proximal and distal margins were uninvolved by tumor, and the median number of lymph nodes retrieval in the thoracic region was 22.5lymph nodes (14-73lymph nodes). 41.7% of patients were classified in pathological stage I. Conclusion Robotic-assisted thoracoscopic esophagectomy has shown promising early postoperative outcomes, low blood loss volume, short ICU and hospital stay, a low rate of pulmonary complications and including adequate lymph node retrieval and pathological results. These findings support the feasibility and safety of robotic-assisted thoracoscopic esophagectomy, which enhance postoperative recovery and improve surgical outcomes for the treatment of esophageal squamous cell carcinoma.