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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Article info
Publication history
Published online: November 19, 2021
Accepted:
November 16,
2021
Received:
November 3,
2021
Identification
Copyright
© 2021 Published by Elsevier Ltd.