Abstract
BackgroundThe present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.MethodsPatients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.ResultsSixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements).ConclusionsAlthough further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.Trial registrationThis trial was registered in the UMIN Clinical Trial Registry (UMIN000017565 14/05/2015).
Highlights
The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer
All the patients were offered the option of surgery (TTE or robot-assisted transmediastinal esophagectomy (TME)), and robot-assisted TME was performed in patients who elected to undergo this procedure despite lack of coverage under National Health Insurance
TME preserves the respiratory muscles and avoids adhesion associated with thoracotomy; this likely explains the postoperatively preservation of the respiratory function in TME
Summary
The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer. Video-assisted thoracoscopic esophagectomy is regarded as a minimally invasive surgical technique for esophageal cancer [3,4,5] and has the advantage of less postoperative pain and faster lung capacity recovery than seen in transthoracic esophagectomy (TTE) [6, 7]. A study comparing TTE with video-assisted thoracoscopic esophagectomy based on the aforementioned National Clinical Database showed no significant decrease in the length of hospital stay or any significant reduction in postoperative mortality. Despite being considered a minimally invasive procedure, video-assisted thoracoscopic esophagectomy had no significant positive impact on the pulmonary complication rate. Transhiatal esophagectomy is a favored choice and is associated with lower perioperative morbidity, but the oncological outcome of this approach is generally considered to be inferior because fewer lymph nodes can be harvested than in the transthoracic approach [8]
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