Robotic Minimally Invasive Esophagectomy (RAMIE) vs. Open Esophagectomy (OE) for Resectable Esophageal Cancer

Abstract

Robotic surgery continues to expand, and is currently being used as an alternative approach to esophagectomy. Current literature on robotic assisted minimally invasive esophagectomy (RAMIE) remains limited. All available literature comparing RAMIE to open esophagectomy (OE) was reviewed. There is moderate evidence to suggest a benefit of RAMIE over OE in terms of pulmonary and infectious postoperative complications, with other complications being similar between the two approaches. There is limited data on long term cancer survival as the RAMIE technique remains in its relative infancy. There is some evidence of improved lymphadenectomy with RAMIE. Given the potential beneficial impact of number of surgically removed lymph nodes on overall cancer survival, improved lymphadenectomy with RAMIE may be advantageous from an oncologic standpoint. Compared to OE, current data suggests specific improved perioperative and quality of life outcomes with RAMIE. Based on current data, the authors believe RAMIE is an acceptable alternative to OE for resectable esophageal cancer, and may provide certain advantages over OE, but the strength of recommendation for RAMIE over OE is weak given the overall paucity of high-level prospective and randomized data comparing the two approaches.