Lower Incidence of Postoperative Pulmonary Complications Following Robot-Assisted Minimally Invasive Esophagectomy for E
- PDF / 347,311 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 75 Downloads / 185 Views
ORIGINAL ARTICLE – THORACIC ONCOLOGY
Lower Incidence of Postoperative Pulmonary Complications Following Robot-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: Propensity Score-Matched Comparison to Conventional Minimally Invasive Esophagectomy Shigeru Tsunoda, MD, PhD, FACS1 , Kazutaka Obama, MD, PhD, FACS1, Shigeo Hisamori, MD, PhD, FACS1, Tatsuto Nishigori, MD, PhD, FACS1,2, Ryosuke Okamura, MD, PhD1, Hisatsugu Maekawa, MD, PhD1, and Yoshiharu Sakai, MD, PhD, FACS1 1
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 2Patients Safety Unit, Kyoto University Hospital, Kyoto, Japan
ABSTRACT Background. Whether robot-assisted minimally invasive surgery (RAMIE) is more beneficial than conventional minimally invasive surgery (MIE) remains unclear. Methods. In total, 165 consecutive patients with esophageal carcinoma who underwent esophagectomy between January 2015 and April 2020 were retrospectively assessed. A 1:1 propensity score matching analysis was performed to compare the short-term outcomes between RAMIE and conventional MIE. Results. After matching, 45 patients were included in the RAMIE and conventional MIE groups. RAMIE had a significantly longer total operative time (708 vs. 612 min, P \ 0.001) and thoracic operative time (348 vs. 285 min, P\0.001) than conventional MIE. However, there were no significant differences in terms of oncological outcomes, such as R0 resection rate and number of resected lymph nodes. The overall postoperative morbidity (Clavien– Dindo [C–D] grade II or higher) rate of RAMIE and conventional MIE were 51% and 73% (P = 0.03), respectively, and the severe postoperative morbidity (C–D grade III or higher) rates were 11% and 29% (P = 0.04), respectively. The incidence rate of recurrent laryngeal nerve palsy was halved in RAMIE (7%) compared with conventional MIE
Ó Society of Surgical Oncology 2020 First Received: 13 May 2020 Accepted: 12 July 2020 S. Tsunoda, MD, PhD, FACS e-mail: [email protected]
(20%) (P = 0.06). Finally, the pulmonary complication rate (18%) was significantly lower in patients who underwent RAMIE than in those who underwent conventional MIE (44%) (P = 0.006). Conclusions. RAMIE was safe and feasible, even during the early period of its application at a specialized center. Moreover, it may be a promising alternative to conventional MIE, with better short-term outcomes, including significantly lower incidence of pulmonary complications.
Esophageal cancer is the sixth leading cause of cancer related death worldwide.1 Surgical resection remains the mainstay of treatment even with the sophistication of multidisciplinary therapies, including endoscopic treatment for superficial cancer and definitive chemoradiotherapy.2 However, esophagectomy is considered one of the most invasive surgeries for gastrointestinal malignancies, and it often is accompanied by surgical morbidity, including recurrent laryngeal nerve (RLN) palsy, pneumonia, and anastomotic leakage. To reduce invasiveness, minimally invasive esophagec
Data Loading...
