Robotic versus thoraco-laparoscopic minimally invasive Ivor Lewis esophagectomy, a matched-pair single-center cohort analysis
Minimally invasive esophagectomy (MIE) is becoming more widespread with a documented improvement in postoperative morbidity based on level I evidence. However, there is a lack of consensus regarding the optimal MIE approach, conventional thoracoscopy/laparoscopy vs robotics as well as the ideal anas...
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| Veröffentlicht in: | Diseases of the esophagus 2022-12, Vol.36 (1) |
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| container_title | Diseases of the esophagus |
| container_volume | 36 |
| creator | Chouliaras, Konstantinos Attwood, Kristopher Brady, Maureen Takahashi, Hideo Peng, June S Yendamuri, Sai Demmy, Todd L Hochwald, Steven N Kukar, Moshim |
| description | Minimally invasive esophagectomy (MIE) is becoming more widespread with a documented improvement in postoperative morbidity based on level I evidence. However, there is a lack of consensus regarding the optimal MIE approach, conventional thoracoscopy/laparoscopy vs robotics as well as the ideal anastomotic technique. All patients who underwent MIE via an Ivor Lewis approach with a side-to-side stapled anastomosis were included. The thoracoscopy-laparoscopy (TL) group was compared to the robotic group with respect to perioperative outcomes using the entire cohorts and after 1:1 propensity score matching. Comparisons were made using the Mann-Whitney U and Fisher's exact tests. Between July 2013 and November 2020, 72 TL and 67 robotic Ivor Lewis MIE were performed. After comparing the two unadjusted cohorts and 51 propensity matched pairs, there was a decrease in Clavien-Dindo Grade 2 or above complications in the robotic vs TL group (59.7% vs 41.8% [P = 0.042], (62.7% vs 39.2% [P = 0.029]), respectively. In both analyses, there was a reduction in hospital length of stay (median of 8 vs 7 days, P |
| doi_str_mv | 10.1093/dote/doac037 |
| format | Article |
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However, there is a lack of consensus regarding the optimal MIE approach, conventional thoracoscopy/laparoscopy vs robotics as well as the ideal anastomotic technique. All patients who underwent MIE via an Ivor Lewis approach with a side-to-side stapled anastomosis were included. The thoracoscopy-laparoscopy (TL) group was compared to the robotic group with respect to perioperative outcomes using the entire cohorts and after 1:1 propensity score matching. Comparisons were made using the Mann-Whitney U and Fisher's exact tests. Between July 2013 and November 2020, 72 TL and 67 robotic Ivor Lewis MIE were performed. After comparing the two unadjusted cohorts and 51 propensity matched pairs, there was a decrease in Clavien-Dindo Grade 2 or above complications in the robotic vs TL group (59.7% vs 41.8% [P = 0.042], (62.7% vs 39.2% [P = 0.029]), respectively. In both analyses, there was a reduction in hospital length of stay (median of 8 vs 7 days, P < 0.001) and a trend toward less anastomotic leaks in the robotic group (Unadjusted: 12.5 vs 3% [P = 0.057], Propensity-matched analysis: 13.7% vs 3.9% [P = 0.16]), respectively. A clinically significant decrease in overall morbidity, cardiac complications and hospital length of stay was observed in the robotic Ivor Lewis cohort when compared with the TL group at a high volume MIE program. Side-to-side stapled thoracic anastomoses utilizing a robotic platform provides the best outcomes in this single institution experience.</description><identifier>ISSN: 1120-8694</identifier><identifier>EISSN: 1442-2050</identifier><identifier>DOI: 10.1093/dote/doac037</identifier><identifier>PMID: 35758409</identifier><language>eng</language><publisher>United States</publisher><subject>Anastomosis, Surgical - methods ; Cohort Studies ; Esophageal Neoplasms - surgery ; Esophagectomy - adverse effects ; Esophagectomy - methods ; Humans ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Minimally Invasive Surgical Procedures - adverse effects ; Minimally Invasive Surgical Procedures - methods ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - surgery ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Diseases of the esophagus, 2022-12, Vol.36 (1)</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c291t-b94fb033e5a26a8e8441f7e41ed81047f39ecd93d694338741e7756ba6bf26593</citedby><cites>FETCH-LOGICAL-c291t-b94fb033e5a26a8e8441f7e41ed81047f39ecd93d694338741e7756ba6bf26593</cites><orcidid>0000-0002-6331-327X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35758409$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chouliaras, Konstantinos</creatorcontrib><creatorcontrib>Attwood, Kristopher</creatorcontrib><creatorcontrib>Brady, Maureen</creatorcontrib><creatorcontrib>Takahashi, Hideo</creatorcontrib><creatorcontrib>Peng, June S</creatorcontrib><creatorcontrib>Yendamuri, Sai</creatorcontrib><creatorcontrib>Demmy, Todd L</creatorcontrib><creatorcontrib>Hochwald, Steven N</creatorcontrib><creatorcontrib>Kukar, Moshim</creatorcontrib><title>Robotic versus thoraco-laparoscopic minimally invasive Ivor Lewis esophagectomy, a matched-pair single-center cohort analysis</title><title>Diseases of the esophagus</title><addtitle>Dis Esophagus</addtitle><description>Minimally invasive esophagectomy (MIE) is becoming more widespread with a documented improvement in postoperative morbidity based on level I evidence. However, there is a lack of consensus regarding the optimal MIE approach, conventional thoracoscopy/laparoscopy vs robotics as well as the ideal anastomotic technique. All patients who underwent MIE via an Ivor Lewis approach with a side-to-side stapled anastomosis were included. The thoracoscopy-laparoscopy (TL) group was compared to the robotic group with respect to perioperative outcomes using the entire cohorts and after 1:1 propensity score matching. Comparisons were made using the Mann-Whitney U and Fisher's exact tests. Between July 2013 and November 2020, 72 TL and 67 robotic Ivor Lewis MIE were performed. After comparing the two unadjusted cohorts and 51 propensity matched pairs, there was a decrease in Clavien-Dindo Grade 2 or above complications in the robotic vs TL group (59.7% vs 41.8% [P = 0.042], (62.7% vs 39.2% [P = 0.029]), respectively. In both analyses, there was a reduction in hospital length of stay (median of 8 vs 7 days, P < 0.001) and a trend toward less anastomotic leaks in the robotic group (Unadjusted: 12.5 vs 3% [P = 0.057], Propensity-matched analysis: 13.7% vs 3.9% [P = 0.16]), respectively. A clinically significant decrease in overall morbidity, cardiac complications and hospital length of stay was observed in the robotic Ivor Lewis cohort when compared with the TL group at a high volume MIE program. Side-to-side stapled thoracic anastomoses utilizing a robotic platform provides the best outcomes in this single institution experience.</description><subject>Anastomosis, Surgical - methods</subject><subject>Cohort Studies</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - adverse effects</subject><subject>Esophagectomy - methods</subject><subject>Humans</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - methods</subject><subject>Minimally Invasive Surgical Procedures - adverse effects</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - surgery</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>1120-8694</issn><issn>1442-2050</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kE1LxDAQhoMoft88S44erCZN2iZHEb9gQRA9l2k63Y20TU2yK3vwv5tlVy8zA_PwwvsQcsHZDWda3LYuYhpgmKj2yDGXMs9yVrD9dPOcZarU8oichPDJGK9EqQ7JkSiqQkmmj8nPm2tctIau0IdloHHhPBiX9TCBd8G4Kf0GO9oB-n5N7biCYFdIX1bO0xl-20AxuGkBczTRDetrCnSAaBbYZhNYT4Md5z1mBseInhqX8iOFEfp1sOGMHHTQBzzf7VPy8fjwfv-czV6fXu7vZpnJNY9Zo2XXMCGwgLwEhUpK3lUoObaKM1l1QqNptWhTVSFUlR5VVZQNlE2Xl4UWp-Rqmzt597XEEOvBBoN9DyO6ZajzUiVvXBcqoddb1KT6wWNXTz6V9-uas3ojvN4Ir3fCE365S142A7b_8J9h8Qs7AIBI</recordid><startdate>20221231</startdate><enddate>20221231</enddate><creator>Chouliaras, Konstantinos</creator><creator>Attwood, Kristopher</creator><creator>Brady, Maureen</creator><creator>Takahashi, Hideo</creator><creator>Peng, June S</creator><creator>Yendamuri, Sai</creator><creator>Demmy, Todd L</creator><creator>Hochwald, Steven N</creator><creator>Kukar, Moshim</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6331-327X</orcidid></search><sort><creationdate>20221231</creationdate><title>Robotic versus thoraco-laparoscopic minimally invasive Ivor Lewis esophagectomy, a matched-pair single-center cohort analysis</title><author>Chouliaras, Konstantinos ; Attwood, Kristopher ; Brady, Maureen ; Takahashi, Hideo ; Peng, June S ; Yendamuri, Sai ; Demmy, Todd L ; Hochwald, Steven N ; Kukar, Moshim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c291t-b94fb033e5a26a8e8441f7e41ed81047f39ecd93d694338741e7756ba6bf26593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anastomosis, Surgical - methods</topic><topic>Cohort Studies</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - adverse effects</topic><topic>Esophagectomy - methods</topic><topic>Humans</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - methods</topic><topic>Minimally Invasive Surgical Procedures - adverse effects</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - surgery</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chouliaras, Konstantinos</creatorcontrib><creatorcontrib>Attwood, Kristopher</creatorcontrib><creatorcontrib>Brady, Maureen</creatorcontrib><creatorcontrib>Takahashi, Hideo</creatorcontrib><creatorcontrib>Peng, June S</creatorcontrib><creatorcontrib>Yendamuri, Sai</creatorcontrib><creatorcontrib>Demmy, Todd L</creatorcontrib><creatorcontrib>Hochwald, Steven N</creatorcontrib><creatorcontrib>Kukar, Moshim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the esophagus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chouliaras, Konstantinos</au><au>Attwood, Kristopher</au><au>Brady, Maureen</au><au>Takahashi, Hideo</au><au>Peng, June S</au><au>Yendamuri, Sai</au><au>Demmy, Todd L</au><au>Hochwald, Steven N</au><au>Kukar, Moshim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robotic versus thoraco-laparoscopic minimally invasive Ivor Lewis esophagectomy, a matched-pair single-center cohort analysis</atitle><jtitle>Diseases of the esophagus</jtitle><addtitle>Dis Esophagus</addtitle><date>2022-12-31</date><risdate>2022</risdate><volume>36</volume><issue>1</issue><issn>1120-8694</issn><eissn>1442-2050</eissn><abstract>Minimally invasive esophagectomy (MIE) is becoming more widespread with a documented improvement in postoperative morbidity based on level I evidence. However, there is a lack of consensus regarding the optimal MIE approach, conventional thoracoscopy/laparoscopy vs robotics as well as the ideal anastomotic technique. All patients who underwent MIE via an Ivor Lewis approach with a side-to-side stapled anastomosis were included. The thoracoscopy-laparoscopy (TL) group was compared to the robotic group with respect to perioperative outcomes using the entire cohorts and after 1:1 propensity score matching. Comparisons were made using the Mann-Whitney U and Fisher's exact tests. Between July 2013 and November 2020, 72 TL and 67 robotic Ivor Lewis MIE were performed. After comparing the two unadjusted cohorts and 51 propensity matched pairs, there was a decrease in Clavien-Dindo Grade 2 or above complications in the robotic vs TL group (59.7% vs 41.8% [P = 0.042], (62.7% vs 39.2% [P = 0.029]), respectively. In both analyses, there was a reduction in hospital length of stay (median of 8 vs 7 days, P < 0.001) and a trend toward less anastomotic leaks in the robotic group (Unadjusted: 12.5 vs 3% [P = 0.057], Propensity-matched analysis: 13.7% vs 3.9% [P = 0.16]), respectively. A clinically significant decrease in overall morbidity, cardiac complications and hospital length of stay was observed in the robotic Ivor Lewis cohort when compared with the TL group at a high volume MIE program. Side-to-side stapled thoracic anastomoses utilizing a robotic platform provides the best outcomes in this single institution experience.</abstract><cop>United States</cop><pmid>35758409</pmid><doi>10.1093/dote/doac037</doi><orcidid>https://orcid.org/0000-0002-6331-327X</orcidid></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Anastomosis, Surgical - methods Cohort Studies Esophageal Neoplasms - surgery Esophagectomy - adverse effects Esophagectomy - methods Humans Laparoscopy - adverse effects Laparoscopy - methods Minimally Invasive Surgical Procedures - adverse effects Minimally Invasive Surgical Procedures - methods Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Retrospective Studies Treatment Outcome |
| title | Robotic versus thoraco-laparoscopic minimally invasive Ivor Lewis esophagectomy, a matched-pair single-center cohort analysis |
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