414. SHORT-TERM CLINICAL EFFECT OF ROBOT-ASSISTED ESOPHAGECTOMY WITH THORACIC DUCT RESECTION

Abstract

Abstract Whether extended robot-assisted esophagectomy with thoracic duct resection (RAE-TDR) has a favorable impact on esophageal cancer patients remains not well defined. This study aimed to analyze safety and efficiency of RAE-TDR. From January 2019 to July 2020, 73 consecutive patients with TD-resected and 127 consecutive patients with TD-preserved were enrolled, who received standard RAE McKeown surgery. Perioperative related indicators, RFS and OS at 1-year were compared between the two groups. Morbidity of Clavien–Dindo classification grade ≥ II or III were similar (p > 0.05). The number of retrieved total lymph nodes and mediastinal nodes were significantly higher in the TD-resected group (29.0 ± 11.1 vs 25.1 ± 8.5, p = 0.006 and 2.3 ± 3.7 vs 1.7 ± 2.8, p = 0.002, respectively). Moreover, more metastatic TD-related lymph nodes were harvested in cT3–4 patients (2.3 ± 3.7 vs 1.7 ± 2.8，p = 0.21). The rate of LN recurrence and local recurrence were similar (6.8% vs 7.1%, p > 0.99 and 1.4% vs 2.4%, p > 0.99, respectively). OS and RFS at 1-year were equivalent regardless of the TD procedure in each stage (p > 0.05). However, Hematogenous metastasis in TD-resected group was significantly elevated (17.8% vs 7.9%, p = 0.034). RAE-TDR may help to improve total and metastatic LNs harvest, especially for patients with advanced ESCC without increasing adverse events intra- and post-operation. However, RAE-TDR does not bring about a decrease in local recurrence rate within short-term follow-up. We are not sure whether the increase in distant metastasis rate in the RAE-TDR group is associated with relevant immune system damage. Therefore, non-selective RAE-TDR resection is not routinely recommended.