Comparative outcomes of minimally invasive and robotic-assisted esophagectomy.

Abstract

167 Background: Minimally invasive esophagectomy(MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The addition of robotics has potential to further improve outcomes. We sought to compare the outcomes of existing techniques for MIE with robotic assisted approaches. Methods: Utilizing a prospective esophagectomy database we identified patients who underwent (MIE) via Ivor Lewis(TT), transhiatal(TH) or robotic assisted Ivor Lewis(RAIL) techniques. Patient demographics, tumor characteristics and complications were analyzed via ANOVA, Chi-Square, and Fisher Exact where appropriate. Results: We identified 302 patients who underwent MIE: TT 95(31.5%), TH 63(20.8%), and RAIL 144(47.7%) with a mean age of 65±9.6. The length of operation was longer in the RAIL: TT(299±87), TH(231±65), RAIL(409±104 minutes), p < 0.001. However the EBL was lower in the RAIL patients: TT(189±188ml), TH(242±380ml), RAIL(155±107ml), p = 0.03. Conversion to open was also lower in the RAIL group: TT 7(7.4%), TH 8(12.7%), RAIL 0, p < 0.001. The R0 resection rate and lymph node (LN) harvest also favored the RAIL cohort :TT 86(93.5%), TH 60(96.8%), and RAIL 144(100%), p = 0.01. LN:TT 14±7, TH 9±6, and RAIL 20±9, p < 0.001. The overall morbidity was lower in RAIL patients: TT 29(30.5%), TH 39(61.9%), RAIL 34(23.6%), p < 0.001. Mortality was lower in the TT and RAIL approaches compared to TH but was not significant: TT 2 (2.1%), TH 2 (3.2%), and RAIL 2 (1.4%), p = 0.6. Conclusions: RAIL demonstrates lower EBL, conversion to open, and morbidity than other MIE techniques. Additionally the oncologic outcomes measured by R0 resections and LN harvest also favored the patients who underwent RAIL.