P-OGC87 Robotic Techniques in Esophagogastric Cancer Surgery: An Assessment of Short- and Long-term Clinical Outcomes

Abstract

Abstract Background Robotic esophagogastric cancer surgery is gaining widespread adoption. This population-based cohort study aimed to compare rates of textbook outcomes (TO) and survival from robotic minimally invasive techniques for esophagogastric cancers. Methods Data from the United States National Cancer Database (NCDB) (2010-2017), was used to identify patients with non-metastatic esophageal and gastric cancers receiving open (esophagus, n = 11,442; stomach, n = 22,183), laparoscopic (esophagus (LAMIE), n = 4,827; stomach (LAMIG), n = 6,359) or robotic (esophagus (RAMIE), n = 1,657; stomach (RAMIG), n = 1,718) surgery. TO were defined as lymph nodes examined >15, margin-negative resections, length of stay <21 days, no 30-day readmission, and no 90-day mortality. Multivariable logistic regression and Cox analyses were used to account for treatment selection bias. Results Patients receiving robotic surgery were more commonly treated within high volume, academic centers and with advanced clinical T and N stage disease. From 2010 to 2017, TO rates increased for esophageal and gastric cancer treated by all surgical techniques. RAMIE (odds ratio (OR):1.41, (CI 95% : 1.27-1.58) and RAMIG (OR:1.30, CI 95% : 1.17-1.45) had significantly higher TO rates compared to open surgery. For esophagectomy, TO (hazard ratio (HR):0.64, CI 95% : 0.60-0.67) and RAMIE (HR:0.92, CI 95% : 0.84-1.00) were both associated with long-term survival. For gastrectomy, TO (HR:0.58, CI 95% : 0.56-0.60) and both LAMIG (HR:0.89, CI 95% : 0.85-0.94) and RAMIG (HR:0.88, CI 95% : 0.81-0.96) were all associated with long-term survival. Subset analysis in high volume centers confirmed similar findings. Conclusions Despite potentially adverse learning curve effects and more advanced tumor stages captured within the study period, both RAMIE and RAMIG, as performed in mostly high-volume centers, were associated with improved TO and long-term survival. Therefore, consideration for wider adoption but a well-designed phase III RCT is required to fully evaluate the benefits of robotic techniques in esophageal and gastric cancers.