PS01.240: ROBOTIC ESOPHAGECTOMY USING THE DA VINCI XI: INITIAL EXPERIENCE FROM A TERTIARY CANCER CENTRE

Abstract

Abstract Background Esophagectomy is a daunting procedure with a steep learning curve. Minimally invasive esophagectomy is associated with reduced perioperative complications. However, most studies so far have evaluated thoracoscopic or laparoscopic approaches. We describe our initial experience with robotic esophagectomy using the da Vinci Xi system. Methods We performed a retrospective analysis of a prospectively maintained database of patients operated with radical intent for esophageal cancer between November 2014 and November 2017. Results Thirty-four of the 483 curative esophagectomies were performed robotically. We performed the thoracic part in the semi-prone position and the abdominal part in a supine position. The thoracic component of the procedure was completed robotically in all 34 patients. For the abdominal approach, 19(55.9%) patients underwent gastric mobilization by the robotic approach, 9(26.5%) by the laparoscopic approach, and 6(17.6%) by laporotomy. The median age was 51 years and 76.5% of the patients were male. 73.5% of the patients had T3 tumours and 52.9% of the patients did not have significant nodes (N0) on preoperative imaging by PET-CT. 70.6% of the patients received neoadjuvant chemotherapy and 2.9% of the patients received neoadjuvant chemoradiotherapy. Standard two field (infracarinal and abdominal) lymphadenectomy was performed in 88.2% and three field lymphadenectomy in 11.8%. The median blood loss was 275 ml, with 85% of patients having blood loss below 400ml. The total surgical time (including docking and changing patient position) was 390 min. No patient needed intra or post-operative blood transfusion. Median ICU and hospital stay were 0.6 days and 10 days respectively. Major morbidity (Clavin-Dindo score > 3A) occurred in 17.6% with one post-operative mortality (2.9%). Pulmonary complications were seen in 8.8% and anastomotic leak in 11.8%. The median lymph nodes retrieved were 18. At a median of 24-months follow-up, the disease free survival was 58%, and the overall survival was 70%. Conclusion Transthoracic total esophagectomy is safe and feasible through the robotic approach. Larger studies with longer follow-up are needed to establish robotic esophagectomy as a standard surgical option for patients with esophageal cancer. Disclosure All authors have declared no conflicts of interest.