Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center
Introduction Transthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive...
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| creator | Babic, Benjamin Müller, Dolores T. Jung, Jin-On Schiffmann, Lars M. Grisar, Paula Schmidt, Thomas Chon, Seung-Hun Schröder, Wolfgang Bruns, Christiane J. Fuchs, Hans F. |
| description | Introduction
Transthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive esophagectomy (MIE), and most recently to robot-assisted minimally invasive esophagectomy (RAMIE), with each step demonstrating improved patient outcomes. Aim of this study with more than 600 patients is to complete a propensity-score matched comparison of postoperative short-term outcomes after highly standardized RAMIE vs. HE in a European high volume center.
Patients and Methods
Six hundred and eleven patients that underwent transthoracic Ivor–Lewis esophagectomy for esophageal cancer between May 2016 and May 2021 were included in the study. In January 2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and ICG (indocyanine green) for RAMIE cases. Data were retrospectively analyzed from a prospectively maintained IRB-approved database. Outcomes of patients undergoing standardized RAMIE from January 2019 to May 2021 were compared to our overall cohort from May 2016–April 2021 (HE) after a propensity-score matching analysis was performed.
Results
Six hundred and eleven patients were analyzed. 107 patients underwent RAMIE. Of these, a total of 76 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis (RAMIE group). A total of 535 patients underwent HE (Hybrid group). Seventy patients were propensity-score matched in each group and analysis revealed no statistically significant differences in baseline characteristics. RAMIE patients had a significantly shorter ICU stay (
p
= 0.0218). Significantly more patients had no postoperative complications (Clavien Dindo 0) in the RAMIE group [47.1% vs. 27.1% in the HE group (
p
= 0.0225)]. No difference was seen in lymph node yield and R0 resection rates. Anastomotic leakage rates when matched were 14.3% in the hybrid group vs. 4.3% in the RAMIE group (
p
= 0.07).
Conclusion
Our analysis confirms the safety and feasibility of RAMIE and HE in a large cohort after propensity score matching. A regular postoperative course (Clavien–Dindo 0) and a shorter ICU stay were seen significantly more often after RAMIE compared to HE. Furthermore it shows that both procedures provide excellent short-term oncologic outcomes, rega |
| doi_str_mv | 10.1007/s00464-022-09254-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9485091</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2659604784</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-59e29b1ed141b52f0c99cc150218b9ba6c320f2feae42d56b05fcf38316e10e93</originalsourceid><addsrcrecordid>eNqFks1u1DAUhS0EokPhBVggS2zKwsV27GTMAqmqBqjUCqmCteV4biaukjjYTqS8Gk-Hhylt6QJWd3G_c-6PDkKvGT1llFbvI6WiFIRyTqjiUhD-BK2YKDjhnK2fohVVBSW8UuIIvYjxhmZeMfkcHRVSUsmlWqGf1772iZgYXUywxb0bXG-6bsFumE10M2CIfmzNDmzy_YJPrs-uLjbv8BxPcbvUwf1f8wGPwY8wRJcWHK0PgHuTbJvHxdaHRBKEHvspWd8DNoPplrwN9g02eDPtpWbArdu1ZPbdlBELQ5a8RM8a00V4dVuP0fdPm2_nX8jl188X52eXxIpKJCIVcFUz2DLBaskbapWylkmaf1Sr2pS24LThDRgQfCvLmsrGNsW6YCUwCqo4Rh8PvuNU97DdDw-m02PIR4dFe-P0353BtXrnZ63EWlLFssHJrUHwPyaISfcuWug6M4CfoualVCUV1Vpk9O0j9MZPIX8kUxWTJStFsaf4gbLBxxiguVuGUb2Phj5EQ-do6N_R0DyL3jw8407yJwsZKA5AzK1hB-F-9j9sfwEM5MoX</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2715616434</pqid></control><display><type>article</type><title>Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Babic, Benjamin ; Müller, Dolores T. ; Jung, Jin-On ; Schiffmann, Lars M. ; Grisar, Paula ; Schmidt, Thomas ; Chon, Seung-Hun ; Schröder, Wolfgang ; Bruns, Christiane J. ; Fuchs, Hans F.</creator><creatorcontrib>Babic, Benjamin ; Müller, Dolores T. ; Jung, Jin-On ; Schiffmann, Lars M. ; Grisar, Paula ; Schmidt, Thomas ; Chon, Seung-Hun ; Schröder, Wolfgang ; Bruns, Christiane J. ; Fuchs, Hans F.</creatorcontrib><description>Introduction
Transthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive esophagectomy (MIE), and most recently to robot-assisted minimally invasive esophagectomy (RAMIE), with each step demonstrating improved patient outcomes. Aim of this study with more than 600 patients is to complete a propensity-score matched comparison of postoperative short-term outcomes after highly standardized RAMIE vs. HE in a European high volume center.
Patients and Methods
Six hundred and eleven patients that underwent transthoracic Ivor–Lewis esophagectomy for esophageal cancer between May 2016 and May 2021 were included in the study. In January 2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and ICG (indocyanine green) for RAMIE cases. Data were retrospectively analyzed from a prospectively maintained IRB-approved database. Outcomes of patients undergoing standardized RAMIE from January 2019 to May 2021 were compared to our overall cohort from May 2016–April 2021 (HE) after a propensity-score matching analysis was performed.
Results
Six hundred and eleven patients were analyzed. 107 patients underwent RAMIE. Of these, a total of 76 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis (RAMIE group). A total of 535 patients underwent HE (Hybrid group). Seventy patients were propensity-score matched in each group and analysis revealed no statistically significant differences in baseline characteristics. RAMIE patients had a significantly shorter ICU stay (
p
= 0.0218). Significantly more patients had no postoperative complications (Clavien Dindo 0) in the RAMIE group [47.1% vs. 27.1% in the HE group (
p
= 0.0225)]. No difference was seen in lymph node yield and R0 resection rates. Anastomotic leakage rates when matched were 14.3% in the hybrid group vs. 4.3% in the RAMIE group (
p
= 0.07).
Conclusion
Our analysis confirms the safety and feasibility of RAMIE and HE in a large cohort after propensity score matching. A regular postoperative course (Clavien–Dindo 0) and a shorter ICU stay were seen significantly more often after RAMIE compared to HE. Furthermore it shows that both procedures provide excellent short-term oncologic outcomes, regarding lymph node harvest and R0 resection rates. A randomized controlled trial comparing RAMIE and HE is still pending and will hopefully contribute to ongoing discussions.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09254-2</identifier><identifier>PMID: 35505259</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2021 EAES Oral ; Abdominal Surgery ; Clinical outcomes ; Endoscopy ; Esophageal cancer ; Esophageal Neoplasms - surgery ; Esophagectomy - methods ; Europe ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals, High-Volume ; Humans ; Lymphatic system ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgical Procedures - methods ; Morbidity ; Mortality ; Ostomy ; Patients ; Proctology ; Propensity Score ; Retrospective Studies ; Robotic Surgical Procedures - methods ; Robotics ; Robots ; Surgery ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2022-10, Vol.36 (10), p.7747-7755</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-59e29b1ed141b52f0c99cc150218b9ba6c320f2feae42d56b05fcf38316e10e93</citedby><cites>FETCH-LOGICAL-c474t-59e29b1ed141b52f0c99cc150218b9ba6c320f2feae42d56b05fcf38316e10e93</cites><orcidid>0000-0003-0313-6862</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09254-2$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09254-2$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,777,781,882,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35505259$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Babic, Benjamin</creatorcontrib><creatorcontrib>Müller, Dolores T.</creatorcontrib><creatorcontrib>Jung, Jin-On</creatorcontrib><creatorcontrib>Schiffmann, Lars M.</creatorcontrib><creatorcontrib>Grisar, Paula</creatorcontrib><creatorcontrib>Schmidt, Thomas</creatorcontrib><creatorcontrib>Chon, Seung-Hun</creatorcontrib><creatorcontrib>Schröder, Wolfgang</creatorcontrib><creatorcontrib>Bruns, Christiane J.</creatorcontrib><creatorcontrib>Fuchs, Hans F.</creatorcontrib><title>Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
Transthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive esophagectomy (MIE), and most recently to robot-assisted minimally invasive esophagectomy (RAMIE), with each step demonstrating improved patient outcomes. Aim of this study with more than 600 patients is to complete a propensity-score matched comparison of postoperative short-term outcomes after highly standardized RAMIE vs. HE in a European high volume center.
Patients and Methods
Six hundred and eleven patients that underwent transthoracic Ivor–Lewis esophagectomy for esophageal cancer between May 2016 and May 2021 were included in the study. In January 2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and ICG (indocyanine green) for RAMIE cases. Data were retrospectively analyzed from a prospectively maintained IRB-approved database. Outcomes of patients undergoing standardized RAMIE from January 2019 to May 2021 were compared to our overall cohort from May 2016–April 2021 (HE) after a propensity-score matching analysis was performed.
Results
Six hundred and eleven patients were analyzed. 107 patients underwent RAMIE. Of these, a total of 76 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis (RAMIE group). A total of 535 patients underwent HE (Hybrid group). Seventy patients were propensity-score matched in each group and analysis revealed no statistically significant differences in baseline characteristics. RAMIE patients had a significantly shorter ICU stay (
p
= 0.0218). Significantly more patients had no postoperative complications (Clavien Dindo 0) in the RAMIE group [47.1% vs. 27.1% in the HE group (
p
= 0.0225)]. No difference was seen in lymph node yield and R0 resection rates. Anastomotic leakage rates when matched were 14.3% in the hybrid group vs. 4.3% in the RAMIE group (
p
= 0.07).
Conclusion
Our analysis confirms the safety and feasibility of RAMIE and HE in a large cohort after propensity score matching. A regular postoperative course (Clavien–Dindo 0) and a shorter ICU stay were seen significantly more often after RAMIE compared to HE. Furthermore it shows that both procedures provide excellent short-term oncologic outcomes, regarding lymph node harvest and R0 resection rates. A randomized controlled trial comparing RAMIE and HE is still pending and will hopefully contribute to ongoing discussions.</description><subject>2021 EAES Oral</subject><subject>Abdominal Surgery</subject><subject>Clinical outcomes</subject><subject>Endoscopy</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - methods</subject><subject>Europe</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals, High-Volume</subject><subject>Humans</subject><subject>Lymphatic system</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Proctology</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Robotics</subject><subject>Robots</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFks1u1DAUhS0EokPhBVggS2zKwsV27GTMAqmqBqjUCqmCteV4biaukjjYTqS8Gk-Hhylt6QJWd3G_c-6PDkKvGT1llFbvI6WiFIRyTqjiUhD-BK2YKDjhnK2fohVVBSW8UuIIvYjxhmZeMfkcHRVSUsmlWqGf1772iZgYXUywxb0bXG-6bsFumE10M2CIfmzNDmzy_YJPrs-uLjbv8BxPcbvUwf1f8wGPwY8wRJcWHK0PgHuTbJvHxdaHRBKEHvspWd8DNoPplrwN9g02eDPtpWbArdu1ZPbdlBELQ5a8RM8a00V4dVuP0fdPm2_nX8jl188X52eXxIpKJCIVcFUz2DLBaskbapWylkmaf1Sr2pS24LThDRgQfCvLmsrGNsW6YCUwCqo4Rh8PvuNU97DdDw-m02PIR4dFe-P0353BtXrnZ63EWlLFssHJrUHwPyaISfcuWug6M4CfoualVCUV1Vpk9O0j9MZPIX8kUxWTJStFsaf4gbLBxxiguVuGUb2Phj5EQ-do6N_R0DyL3jw8407yJwsZKA5AzK1hB-F-9j9sfwEM5MoX</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>Babic, Benjamin</creator><creator>Müller, Dolores T.</creator><creator>Jung, Jin-On</creator><creator>Schiffmann, Lars M.</creator><creator>Grisar, Paula</creator><creator>Schmidt, Thomas</creator><creator>Chon, Seung-Hun</creator><creator>Schröder, Wolfgang</creator><creator>Bruns, Christiane J.</creator><creator>Fuchs, Hans F.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0313-6862</orcidid></search><sort><creationdate>20221001</creationdate><title>Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center</title><author>Babic, Benjamin ; Müller, Dolores T. ; Jung, Jin-On ; Schiffmann, Lars M. ; Grisar, Paula ; Schmidt, Thomas ; Chon, Seung-Hun ; Schröder, Wolfgang ; Bruns, Christiane J. ; Fuchs, Hans F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-59e29b1ed141b52f0c99cc150218b9ba6c320f2feae42d56b05fcf38316e10e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>2021 EAES Oral</topic><topic>Abdominal Surgery</topic><topic>Clinical outcomes</topic><topic>Endoscopy</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - methods</topic><topic>Europe</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals, High-Volume</topic><topic>Humans</topic><topic>Lymphatic system</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Proctology</topic><topic>Propensity Score</topic><topic>Retrospective Studies</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Robotics</topic><topic>Robots</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Babic, Benjamin</creatorcontrib><creatorcontrib>Müller, Dolores T.</creatorcontrib><creatorcontrib>Jung, Jin-On</creatorcontrib><creatorcontrib>Schiffmann, Lars M.</creatorcontrib><creatorcontrib>Grisar, Paula</creatorcontrib><creatorcontrib>Schmidt, Thomas</creatorcontrib><creatorcontrib>Chon, Seung-Hun</creatorcontrib><creatorcontrib>Schröder, Wolfgang</creatorcontrib><creatorcontrib>Bruns, Christiane J.</creatorcontrib><creatorcontrib>Fuchs, Hans F.</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Babic, Benjamin</au><au>Müller, Dolores T.</au><au>Jung, Jin-On</au><au>Schiffmann, Lars M.</au><au>Grisar, Paula</au><au>Schmidt, Thomas</au><au>Chon, Seung-Hun</au><au>Schröder, Wolfgang</au><au>Bruns, Christiane J.</au><au>Fuchs, Hans F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2022-10-01</date><risdate>2022</risdate><volume>36</volume><issue>10</issue><spage>7747</spage><epage>7755</epage><pages>7747-7755</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Introduction
Transthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive esophagectomy (MIE), and most recently to robot-assisted minimally invasive esophagectomy (RAMIE), with each step demonstrating improved patient outcomes. Aim of this study with more than 600 patients is to complete a propensity-score matched comparison of postoperative short-term outcomes after highly standardized RAMIE vs. HE in a European high volume center.
Patients and Methods
Six hundred and eleven patients that underwent transthoracic Ivor–Lewis esophagectomy for esophageal cancer between May 2016 and May 2021 were included in the study. In January 2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and ICG (indocyanine green) for RAMIE cases. Data were retrospectively analyzed from a prospectively maintained IRB-approved database. Outcomes of patients undergoing standardized RAMIE from January 2019 to May 2021 were compared to our overall cohort from May 2016–April 2021 (HE) after a propensity-score matching analysis was performed.
Results
Six hundred and eleven patients were analyzed. 107 patients underwent RAMIE. Of these, a total of 76 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis (RAMIE group). A total of 535 patients underwent HE (Hybrid group). Seventy patients were propensity-score matched in each group and analysis revealed no statistically significant differences in baseline characteristics. RAMIE patients had a significantly shorter ICU stay (
p
= 0.0218). Significantly more patients had no postoperative complications (Clavien Dindo 0) in the RAMIE group [47.1% vs. 27.1% in the HE group (
p
= 0.0225)]. No difference was seen in lymph node yield and R0 resection rates. Anastomotic leakage rates when matched were 14.3% in the hybrid group vs. 4.3% in the RAMIE group (
p
= 0.07).
Conclusion
Our analysis confirms the safety and feasibility of RAMIE and HE in a large cohort after propensity score matching. A regular postoperative course (Clavien–Dindo 0) and a shorter ICU stay were seen significantly more often after RAMIE compared to HE. Furthermore it shows that both procedures provide excellent short-term oncologic outcomes, regarding lymph node harvest and R0 resection rates. A randomized controlled trial comparing RAMIE and HE is still pending and will hopefully contribute to ongoing discussions.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35505259</pmid><doi>10.1007/s00464-022-09254-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0313-6862</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | 2021 EAES Oral Abdominal Surgery Clinical outcomes Endoscopy Esophageal cancer Esophageal Neoplasms - surgery Esophagectomy - methods Europe Gastroenterology Gynecology Hepatology Hospitals, High-Volume Humans Lymphatic system Medicine Medicine & Public Health Minimally Invasive Surgical Procedures - methods Morbidity Mortality Ostomy Patients Proctology Propensity Score Retrospective Studies Robotic Surgical Procedures - methods Robotics Robots Surgery Treatment Outcome |
| title | Robot-assisted minimally invasive esophagectomy (RAMIE) vs. hybrid minimally invasive esophagectomy: propensity score matched short-term outcome analysis of a European high-volume center |
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