Robot-assisted thoraco-laparoscopic esophagectomy reduces complications

The use of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy led to fewer overall complications, as well as surgery- and pulmonary-related complications, than open transthoracic esophagectomy among patients with resectable esophageal cancer, according to study data presented at the Gastrointestinal Cancers Symposium.

Patients who underwent robot-assisted surgery also had better quality of life and short-term postoperative functional recovery, the research showed.

Perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy is standard curative treatment for patients with esophageal cancer.

In a randomized controlled trial, Pieter Christiaan van der Sluis, MD, MSc, research fellow in the department of surgery at University Medical Center Utrecht in the Netherlands, and colleagues sought to determine whether robot-assisted minimally invasive thoraco-laparoscopic esophagectomy reduced perioperative complications and improved functional recovery compared with open transthoracic esophagectomy.

The researchers randomly assigned 112 patients to the open or robot-assisted procedure.

Manifestation of overall postoperative complications via the modified Clavien-Dindo classification system (grade 2 to 5) served as the primary endpoint.

Postoperative complications occurred more frequently among patients who underwent open transthoracic esophagectomy than robot-assisted esophagectomy (80% vs. 59%; RR = 0.74; 95% CI, 0.57-0.96).

Patients who underwent robot-assisted minimally invasive thoraco-laparoscopic esophagectomy had lower median blood loss than patients who underwent open transthoracic esophagectomy (400 mL vs. 568 mL; P < .001), as well as fewer surgery-related complications (RR = 0.74; 95% CI, 0.57-0.96), pulmonary complications (RR = 0.54; 95% CI, 0.34-0.85) and cardiac complications (RR = 0.47; 95% CI, 0.27-0.83).

The robot-assisted procedure also was associated with lower mean postoperative pain on a visual analogue scale (1.86 vs. 2.62; P < .000).

At postoperative day 14, functional recovery appeared better among patients in the robot-assisted esophagectomy group (RR = 1.48; 95% CI, 1.03-2.13).

Researchers observed a mean difference quality-of-life score of 13.4 (95% CI, 2-24.7; P = .02) at discharge and 11.1 (95% CI, 1-21.1; P = .03) 6 weeks after discharge among the groups, indicating patients who underwent robot-assisted minimally invasive thoraco-laparoscopic esophagectomy had better quality-of-life scores at and after discharge.

The mean cost for robot-assisted minimally invasive thoraco-laparoscopic esophagectomy appeared lower than those of open transthoracic esophagectomy (34.892 euros vs. 39.463 euros; P = .07).

Short-term oncological outcomes — including radicality and number of lymph nodes — as well as long-term outcomes, including OS and DFS, appeared the same in both groups at medium follow-up of 38 months.

“This randomized controlled trial provides evidence for the use of [robot-assisted minimally invasive thoraco-laparoscopic esophagectomy] to improve postoperative outcome [among] patients with resectable esophageal cancer,” the researchers wrote. – by Melinda Stevens

Reference:

van der Sluis PC, et al. Abstract 6. Presented at: Gastrointestinal Cancers Symposium; Jan. 18-20, 2018; San Francisco.

Disclosures: The authors report no relevant financial disclosures.