PS02.007: DEVELOPING A ROBOT-ASSISTED ESOPHAGECTOMY PROGRAM IN A HIGH-VOLUME TRANSHIATAL ESOPHAGECTOMY CENTER

Abstract

Abstract Background Esophagectomies have high morbidity rates regardless of approach. Minimally invasive approaches have been shown to have lower complication rates compared to open operations for Transthoracic and Three-hole (McKeown type) esophagectomies. We examined the perioperative outcomes of a transhiatal robot-assisted approach compared to concurrent transhiatal esophagectomies at the same institution. Methods A retrospective review was performed of all transhiatal and robot-assisted transhiatal esophagectomies performed for esophageal cancer at a single large academic center between January 2013 and December 2017. Outcomes assessed included postoperative complications, procedure time, length of stay, unexpected ICU admissions, 30-day readmission and 30-day mortality. A multivariate logistic regression model, adjusted for demographics, comorbidities and disease severity, was used to evaluate outcomes. Results 378 transhiatal (THE) and 87 robot-assisted (RTHE) esophagectomies met inclusion criteria. RTHE was associated with higher rates of pleural effusion requiring drainage, pneumothorax, pulmonary embolism and respiratory failure, as well as empyema requiring treatment. RTHE was associated with a higher number of lymph nodes resected. 56.3% of RTHEs used epidurals vs. 92.3% of THEs. Epidural use had no statistical association with the incidence of pulmonary complications. Differences in atrial fibrillation, anastomotic leak, pneumonia, procedure length, length of stay, 30-day survival and readmission rates were not statistically significant. Conclusion Implementation of a new robot-assisted transhiatal esophagectomy program was associated with higher rates of pulmonary complications and empyema, although there were no differences in length of stay. Further investigation is needed to understand the difference in complications. Disclosure All authors have declared no conflicts of interest.