Intrathoracic Robotic-Sewn Anastomosis During Ivor Lewis Esophagectomy for Cancer: Back to Basics?

Background To assess the feasibility, clinical utility, and safety of intrathoracic robotic-sewn esophageal anastomosis (IrEA) during Ivor Lewis esophagectomy for adenocarcinoma of the lower third of the esophagus, or cancer at the gastro-esophageal junction type I (Siewert classification). Methods A protocol for completely robotic Ivor Lewis esophagectomy (CrIE) and intrathoracic robotic-sewn anastomosis ( IrEA) was established at the authors’ institutions from January 2015 through December 2019. Overall surgery-related postoperative complications were analyzed. Overall survival and disease-free survival analysis were performed using standard methods. Results The study population consisted of 40 patients. Median operative time was 320 min (sd 62, range 235–500 min), and conversion to open rate was 0%. Anastomotic leak rate was 10%. The mean number of examined lymph nodes (ELN) was 19 (IQR 11–29), and the mean number of positive lymph nodes (PLN) was 3 (IQR 0–5). Short- and long-term surgical and oncological outcomes were comparable at a medium follow-up of 37 months. The median overall survival was 48 months while the mean disease-free survival was 29 months. Conclusion This pilot series, in which an intrathoracic robotic-sewn anastomosis (IrEA) was performed during CrIE, demonstrated the safety and feasibility of this approach. Compared to the current standard of care at a high-volume center, IrEA was associated with better postoperative surgical outcomes and similar oncological outcomes to those reported worldwide today. These results call for further validation in a prospective and controlled setting to be fully incorporated into clinical practice.