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Robot-assisted and conventional minimally invasive esophagectomy are associated with better postoperative results compared to hybrid and open transthoracic esophagectomy

  • Author Footnotes
    1 these authors contributed equally to this work.
    Pieter C. van der Sluis
    Footnotes
    1 these authors contributed equally to this work.
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • Author Footnotes
    1 these authors contributed equally to this work.
    Bejamin Babic
    Footnotes
    1 these authors contributed equally to this work.
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • Eren Uzun
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • E. Tagkalos
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • Felix Berlth
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • Edin Hadzijusufovic
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • Hauke Lang
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
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  • Ines Gockel
    Affiliations
    Department of Visceral, Transplant-, Thoracic- and Vascular Surgery, Department of Operative Medicine (DOPM), University Hospital of Leipzig, Leipzig, Germany
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  • Richard van Hillegersberg
    Affiliations
    Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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  • Peter P. Grimminger
    Correspondence
    Corresponding author. UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University Mainz, Dep. General-, Visceral- and Transplant Surgery, Building 505, 6th floor, Langenbeckstrasse 1, D-55131, Mainz, Germany.
    Affiliations
    Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany
    Search for articles by this author
  • Author Footnotes
    1 these authors contributed equally to this work.
Published:November 19, 2021DOI:https://doi.org/10.1016/j.ejso.2021.11.121

      Abstract

      Background

      Currently 4 surgical techniques are performed for transthoracic esophagectomy (open esophagectomy (OE), hybrid esophagectomy (HE), conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE). Aim of this study was to compare these 4 different esophagectomy approaches regarding postoperative complications and short term oncologic outcomes.

      Methods

      Between 2008 and 2019, consecutive patients who underwent esophagectomy with gastric conduit reconstruction were included in this single center study. The primary outcome of this study was the incidence of postoperative complications.

      Results

      Overall 422 patients (OE (n = 107), HE (n = 101), MIE (n = 91) and RAMIE (n = 123)) were evaluated. Uncomplicated postoperative course was observed in 27% (OE), 34% (HE), 53% (MIE), and 63% (RAMIE) of patients (p < 0.001). Pulmonary complications were observed in 57% (OE), 44% (HE), 28% (MIE), and 21% (RAMIE) of patients (p < 0.001). Cardiac complications were present in 25% (OE), 23% (HE), 9% (MIE), and 11% (RAMIE) of patients (p < 0.001). MIE and RAMIE were associated with fewer wound infections (p < 0.001). Median hospital stay after MIE (13 days) and RAMIE (12 days) was shorter compared to OE (20 days) and HE (17 days) (p < 0.001). A median number of 21 (OE), 23 (HE), 23 (MIE), and 31 (RAMIE) lymph nodes was harvested (p < 0.001).

      Conclusion

      Total minimally invasive esophagectomy (MIE, RAMIE) was associated with a lower overall, pulmonary, cardiac and wound complication rate as well as a shorter hospital stay compared to open or hybrid approach (OE, HE). RAMIE resulted in higher lymph node harvest than MIE.

      Keywords

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