Robotic Three-Field Esophagectomy

Abstract

Robot-assisted minimally invasive esophagectomy (RAMIE) enables meticulous surgery because of the improved visualization system and endo-wrist technology. This chapter demonstrates detailed techniques of three-field RAMIE with early and long-term outcomes. In our institute, the most common indication of RAMIE was esophageal squamous cell carcinoma. Both thoracic and abdominal procedures were performed by a robotic four-arm technique. Four ports in the chest and five ports in the abdomen were made. In the thoracic phase, lymph node dissection along the bilateral recurrent laryngeal nerve (RLN) was performed in most of the patients. In the abdominal phase, robotic mobilization of stomach and intracorporeal gastric tube formation were performed. Cervical anastomosis was performed in majority of patients, and three-field lymph node dissection was performed when indicated. A total of 186 patients underwent RAMIE. Conversion to open thoracotomy was necessary in two (1.1%) patients because of severe pleural adhesion. Complete resection was possible in 179 (96.2%) patients. The mean number of dissected lymph nodes was 44.3 ± 21.2. The 30- and 90-day in-hospital mortality rates were 0.5% and 2.1%, respectively. Overall complication rate was 58.0% and major complication rate (≥ grade 3) was 10.2%. Five-year overall survival rate of the patients who underwent RAMIE was 73.1%. Five-year overall survival rate of the patients who underwent upfront surgery was 75.0% and who underwent neoadjuvant treatment was 59.0%. RAMIE can be performed in patients with esophageal cancer with reliable surgical outcomes. Favorable long-term survival could be achieved by RAMIE in the treatment of esophageal cancer.