OGC V01 Robotic salvage oesophagectomy and extended thoraxic lymphadenectomy

Abstract

Abstract Background One of the options for treating oesophageal squamous cell cancer (SCC) is with definitive chemoradiotherapy, rather than surgery. Although small in number, a subset of these patients develop local recurrence without distant metastases and have no other curative intent treatment option but salvage esophagectomy. However, salvage esophagectomy is associated with high rates of morbidity and mortality, but can offer long-term survival. We demonstrate a case of robotic salvage oesophagectomy, performed in a high volume UK centre. Methods We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 68 year old male patient with a BMI of 24 and performance status of 0, underwent robotic salvage Oesophagectomy for mid oesophageal SCC. Patient was initially treated with definitive chemoradiotherapy, however developed local recurrence, without distant metastasis. Preoperatively staging investigations included endoscopy, endoscopic ultrasound, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET). PET identified an avid node in the tracho-oesophageal groove. Results Patient was on the high dependency unit as per the units routine practice for less than 24 hours and was transferred to our monitored bed on the ward. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged after 10 days. Conclusions We demonstrate a safe robotic technique for performing salvage Oesophagectomy in patients who have previously had chemoradiotherapy.