Hybrid laparoscopic versus fully robot-assisted minimally invasive esophagectomy: an international propensity-score matched analysis of perioperative outcome.

Autor: Jung JO; Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany., de Groot EM; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Kingma BF; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Babic B; Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany., Ruurda JP; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Grimminger PP; Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany., Hölzen JP; Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany., Chao YK; Department of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou Taoyuan, Taoyuan, Taiwan., Haveman JW; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands., van Det MJ; Department of Surgery, ZGT Hospital Almelo, Almelo, The Netherlands., Rouanet P; Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier, France., Benedix F; Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany., Li H; Department of Thoracic Surgery, Ruijin Hospital Shanghai, Shanghai, China., Sarkaria I; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA., van Berge Henegouwen MI; Department of Surgery, University Medical Center Amsterdam, Amsterdam, The Netherlands., van Boxel GI; Department of General Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK., Chiu P; Department of Surgery at Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Egberts JH; Department of Surgery, Israelitisches Krankenhaus Hamburg, Hamburg, Germany., Sallum R; Department of Digestive Surgery, University of São Paulo, São Paulo, Brasil., Immanuel A; Department of Surgery, Royal Victoria Infirmary Newcastle Upon Tyne, Newcastle upon Tyne, UK., Turner P; Department of Oesophagogastric Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK., Low DE; Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center Seattle, Seattle, USA., Hubka M; Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center Seattle, Seattle, USA., Perez D; Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg, Hamburg, Germany., Strignano P; Department of General Surgery, Citta' della Salute e della Scienza Turin, Turin, Italy., Biebl M; Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany., Chaudry MA; Department of Academic Surgery, The Royal Marsden NHS Foundation Trust London, London, UK., Bruns CJ; Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany., van Hillegersberg R; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Fuchs HF; Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany. hans.fuchs@uk-koeln.de.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Jun; Vol. 37 (6), pp. 4466-4477. Date of Electronic Publication: 2023 Feb 17.
DOI: 10.1007/s00464-023-09911-0
Abstrakt: Background: Currently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE).
Methods: This retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers.
Results: After propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml, p = 0.6967), operational time (mean 430.3 min versus 417.7 min, p = 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%, p = 0.560), radical resection (R0) rate (95.6% versus 96.3%, p = 0.8526) and total lymph node yield (mean 30.4 versus 29.5, p = 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%, p = 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%, p < 0.001). The length of stay on intensive care unit (median 3 days versus 2 days, p = 0.0005) and in-hospital (median 15 days versus 12 days, p < 0.0001) were longer for the hybrid laparoscopic RAMIE group.
Conclusions: Hybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.
(© 2023. The Author(s).)
Databáze: MEDLINE
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