Totally minimally invasive laparoscopic robot-assisted Ivor Lewis esophagectomy: improved technique and outcomes over 200 cases.

Autor:	Drake JA; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Sinnamon AJ; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Saeed S; Brown University, Providence, RI, USA., Mehta R; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Palm RF; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Baldonado JJ; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Fontaine JP; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA., Pimiento JM; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal oncology [J Gastrointest Oncol] 2024 Apr 30; Vol. 15 (2), pp. 544-554. Date of Electronic Publication: 2024 Apr 22.
DOI:	10.21037/jgo-23-923
Abstrakt:	Background: Surgical resection of esophageal and gastroesophageal junction cancers is a very complex procedure with step learning curve. New technologies have made minimally invasive surgery possible, but challenges still remain for wide spread adoption of these techniques. This article aims to describe the outcomes and salient technical points of a totally minimally invasive, laparoscopic, robot-assisted Ivor Lewis esophagectomy (LRAMIE). Methods: Retrospective observational cohort study performed at a specialty cancer center using a prospectively maintained institutional database. Patients undergoing LRAMIE (laparoscopic abdomen, robotic chest) from 2014-2023 were included. Patients undergoing transhiatal and three-field esophagectomy were excluded. Operative and postoperative outcomes were compared over the study period to identify potential associations between outcomes over time. Results: Two-hundred patients were identified who underwent LRAMIE. Median age was 65 years and most were male (87.5%). The open conversion rate was 1% (n=2), which occurred within the first 30 cases. Operative time and blood loss were improved at the 60-case mark (P<0.001). Anastomotic stricture rate improved after 50 cases, and leak rate improved after 80 cases. Postoperative length of stay improved at both 50 and 100 cases with a median LOS of 6 days after 100 cases. Rate of postoperative pneumonia, 30- and 90-day mortality were reduced after 100 cases, although not statistically significant for mortality due to too few events. Conclusions: Totally minimally invasive Ivor Lewis esophagectomy at a high-volume center is a safe procedure. Operative outcomes improved significantly after 50-80 cases, followed by improvement in anastomotic results and postoperative outcomes, with corresponding excellent oncologic outcomes. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-23-923/coif). R.M. reports consulting for Eli Lilly and participation on the monitoring board of Arcus Biosciences, Merck, BMS, Astellas, Novartis, Seagen, Natera, Guardant Health, Boston Gene and is a member of the scientific advisory board for Debbie’s Dream foundation. J.J.B. participates in Achilles Monitoring Board. J.P.F. reports consulting for AstraZeneca, Intuitive Surgical and Bristiol Myers Squibb. J.M.P. reports Astellas consulting. The other authors have no conflicts of interest to declare. (2024 Journal of Gastrointestinal Oncology. All rights reserved.)
Databáze:	MEDLINE
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