Short term outcomes of robotic assisted minimally invasive oesophagectomy: A single institutional experience.

Abstract

e16112 Background: With the aim to decrease the rate of pulmonary complications associated with thoracotomy, minimally invasive esophagectomy (MIE) was introduced. Our purpose is to see the feasibility, safety and short-term outcomes of Robot-Assisted MIE (RAMIE). Methods: Seventy-three patients of carcinoma oesophagus who underwent Robotic Esophagectomy from May 2018 to March 2023 were included. Demographic profiles, neoadjuvant therapy, and operative and postoperative outcomes were evaluated. Results: Fifty-three patients were male while 29 were female, with median age of 60 years. Four patients had a previous history of surgery for cancer, 2 had carcinoma colon, one had carcinoma breast and another had carcinoma thyroid. 71% of patients had clinical stage 3 disease and the most common location of the tumour was the middle third (62.7%). 85.3% of patients received neoadjuvant therapy. Eighty percent of our patients underwent Robotic Mc Keown’s Esophagectomy while 20% had Robotic Ivor-Lewis Operation. The thoracic part in 1 patient was converted to open due to extensive adhesions in the right hemithorax. Mean abdominal console time was 146 min (+ 32 min) and thoracic console time was 120 min (+ 39 min); with a total operative time of 314 min (+ 44 min). Intraoperative blood loss was 300 ml (+ 86 ml). Post-operative and short-term outcomes: Out of 75 patients, 74.7% patients recovered well without any major complications. The most common complications were pulmonary (16%). Anastomotic leakage was found in 8 patients of whom 4 patients were managed conservatively, 1 required oesophageal stenting, other 2 had bedside opening of neck wound and 1 required pectoralis major muscle flap cover. Clinically recurrent laryngeal nerve palsy was found in 2 patients while Chylothorax was found in 2 patients. The median ICU stay was 3 days (range 1-28 days), whereas the median hospital stay was 8 days (range 6-38 days). Our 30-day mortality was 1.3% and this patient died on POD8 due to sepsis and respiratory failure, while 90 day mortality was 4%. Oncological Outcomes: Pathological complete response was seen in 21.3% of patients and median lymph nodal yield was 21 nodes (range 9-68). There was one microscopic margin positivity. Conclusions: RAMIE is a technically feasible and safe procedure with good lymph node yield and R0 resections. Postoperative complications and short-term oncologic results are comparable to other high-volume centres.