ROBOTIC TRANSTHORACIC ESOPHAGECTOMY VERSUS THORACOSCOPIC ESOPHAGECTOMY IN COMBINED WITH LAPAROSCOPY FOR ESOPHAGEAL CANCER

Abstract

Background: Extended mediastinal with bilateral recurrent laryngeal nerves (RLNs) lymph node dissection (LND) is critical to curative surgery in the treatment of esophageal squamous cell carcinoma (ESCC). Some reports in Robotic transthoracic esophagectomy (RTE) have some advantages over Thoracoscopic esophagectomy (TE) in increasing the exposure and accuracy of mediastinal LND. However, published data was still limited. Objectives: To evaluate early results of RTE combined with laparoscopy to treat ESCC. Methods: This was a prospective nonrandomized comparative study. All patients who underwent RTE or TE for esophageal squamous cell carcinoma were included in the study. The primary endpoints were operation results, morbidity, and mortality. The secondary endpoint was early oncological results, including lymph node harvested, lymph node metastasis, short-term local recurrence, and survival time. Results: From 8/2018 - 8/2020, at Cho Ray Hospital, we performed 109 cases of esophagectomy for esophageal SCC, of which 19 cases (17.4%) were RTE (group 1), and the other 90 cases (82.6%) were TE (group 2). There was no statistical difference in the staging of group 1 compared to group 2, with predominant cases at stages IB, IIA, and IIB (68.5% vs. 54.4%). Group 1 had a longer operation time than group 2 at the thoracic phase (480 (420-540) vs. 410 (380-450), p=0.001, Mann-Whitney test). Left LRN exposure was better in the RTE group than the TE group; however, LRN injuries seemed to be increased with the RTE group (p=0.028 Fisher’s exact test), probably due to the short learning curve. There was also no difference in the number of mediastinal lymph nodes harvested, including lymph nodes along bilateral LRN. Conclusion: RTE combined with laparoscopy is feasible, safe, and effective in treating esophageal SCC. RTE could be a good option in transthoracic esophagectomy for ESCC.