Robot-assisted minimally invasive esophagectomy for esophageal cancer: clinical report of 75 cases from Shanghai Chest Hospital

Abstract

Objective To review the outcomes of robot-assisted esophagectomy (RAE) for esophageal cancer in Shanghai Chest Hospital, and present the learning curve experience. Methods The clinical data of 75 patients undergoing RAE for esophageal cancer between November 2015 and August 2016 in Shanghai Chest Hospital were reviewed. The demographics, preoperative staging, surgical procedure, resection results and postoperative outcomes were analyzed. Results Among these 75 patients, 53 were males and the other 22 were females, with the mean age of (62.1±8.0)years. Preoperative induction took place in 4 patients(5.3%). The R0 resection rate was 97.3%(73/75). The mean volume of blood loss was (230.7±73.5) ml. The mean total operation time of all patients was (275.2±56.8) min, and the mean thoracic operation time was (95.6±27.5) min. The total operation time of the former 20 cases was significantly longer than that of the latter 55 cases[(318.0±48.1) min vs(259.7±51.8) min, t= 4.391, P<0.001]. The thoracic operation time of the former 20 cases was significantly longer than that of the latter 55 cases[(115.1±29.0) min vs(88.6±23.5) min, t= 4.057, P=0.001]. The mean number of lymph node dissection was 15.9±11.0, the number of thoracic lymph node dissection was 9.8±6.9, and the number of recurrent laryngeal nerve lymph node dissection was 3.3±2.6. When subgrouping according to operation sequencesof 1-20, 21-40, 41-60 and 61-75, the lymph node sampling rates of upper mediastinum were 85.0%, 100.0%, 100.0% and 100.0%, respectively(χ2=8.594, P=0.049), and the lymph node sampling rates along left recurrent laryngeal nerve were 65.0%, 95.0%, 95.0% and 100.0%, respectively(χ2=13.920, P=0.006). The main complications were respiratory failure(5 cases, 6.7%), chylothorax (2 cases, 2.7%), tracheo-esophageal fistula(1 case, 1.3%), pulmonary embolism(1 case, 1.3%) and vocal cord paralysis(VCP)(11 cases, 14.7%). When subgrouping according to operation sequencesof 1-25, 26-50 and 51-75, the incidence of VCP decreased without significant difference(24.0%, 12.0% and 8.0%; χ2=2.770, P=0.250). The median length of hospital stay was 12 d, and there was no 30-day mortality. Conclusions RAE is a safe and feasible alternative for treatment of esophageal cancer, which can improve the efficacy of lymph node dissection, especially for the lymphadenectomy along recurrent laryngeal nerve. The ability to execute a safe thoracicesophagectomy with complete mediastinal lymphadenectomy during RAE is improved over time, plateauing after the first 20 cases. Key words: Robot-assisted surgery; Esophageal cancer; Minimally invasive surgery