Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience
BackgroundAlthough the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-08-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.966321/full |
| _version_ | 1811321101546946560 |
|---|---|
| author | Johanna Betzler Johanna Betzler Johanna Betzler Lea Elfinger Sylvia Büttner Christel Weiß Nuh Rahbari Alexander Betzler Christoph Reißfelder Christoph Reißfelder Mirko Otto Susanne Blank Susanne Blank Susanne Blank Sebastian Schölch Sebastian Schölch Sebastian Schölch |
| author_facet | Johanna Betzler Johanna Betzler Johanna Betzler Lea Elfinger Sylvia Büttner Christel Weiß Nuh Rahbari Alexander Betzler Christoph Reißfelder Christoph Reißfelder Mirko Otto Susanne Blank Susanne Blank Susanne Blank Sebastian Schölch Sebastian Schölch Sebastian Schölch |
| author_sort | Johanna Betzler |
| collection | DOAJ |
| description | BackgroundAlthough the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control.Material and methodsData of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs.Results95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005).ConclusionRobot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage. |
| first_indexed | 2024-04-13T13:10:47Z |
| format | Article |
| id | doaj.art-7fc261bd350549d2b4e16f02cf065139 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T13:10:47Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-7fc261bd350549d2b4e16f02cf0651392022-12-22T02:45:37ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-08-011210.3389/fonc.2022.966321966321Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experienceJohanna Betzler0Johanna Betzler1Johanna Betzler2Lea Elfinger3Sylvia Büttner4Christel Weiß5Nuh Rahbari6Alexander Betzler7Christoph Reißfelder8Christoph Reißfelder9Mirko Otto10Susanne Blank11Susanne Blank12Susanne Blank13Sebastian Schölch14Sebastian Schölch15Sebastian Schölch16Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyJunior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyGerman Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyGerman Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyJunior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyGerman Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyJunior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, GermanyGerman Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, GermanyBackgroundAlthough the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control.Material and methodsData of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs.Results95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005).ConclusionRobot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage.https://www.frontiersin.org/articles/10.3389/fonc.2022.966321/fullminimally invasive esophagectomyesophageal surgeryabdominothoracic esophagectomyrobotic surgeryDaVinci |
| spellingShingle | Johanna Betzler Johanna Betzler Johanna Betzler Lea Elfinger Sylvia Büttner Christel Weiß Nuh Rahbari Alexander Betzler Christoph Reißfelder Christoph Reißfelder Mirko Otto Susanne Blank Susanne Blank Susanne Blank Sebastian Schölch Sebastian Schölch Sebastian Schölch Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience Frontiers in Oncology minimally invasive esophagectomy esophageal surgery abdominothoracic esophagectomy robotic surgery DaVinci |
| title | Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience |
| title_full | Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience |
| title_fullStr | Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience |
| title_full_unstemmed | Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience |
| title_short | Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience |
| title_sort | robot assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer a single center experience |
| topic | minimally invasive esophagectomy esophageal surgery abdominothoracic esophagectomy robotic surgery DaVinci |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.966321/full |
| work_keys_str_mv | AT johannabetzler robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT johannabetzler robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT johannabetzler robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT leaelfinger robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT sylviabuttner robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT christelweiß robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT nuhrahbari robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT alexanderbetzler robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT christophreißfelder robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT christophreißfelder robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT mirkootto robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT susanneblank robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT susanneblank robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT susanneblank robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT sebastianscholch robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT sebastianscholch robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience AT sebastianscholch robotassistedesophagectomymayimproveperioperativeoutcomeinpatientswithesophagealcancerasinglecenterexperience |