Robotic resection for esophageal cancer
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Eur Surg https://doi.org/10.1007/s10353-020-00675-8
Robotic resection for esophageal cancer Jan-Niclas Kersebaum
· Thorben Möller · Thomas Becker · Jan-Hendrik Egberts
Received: 19 March 2020 / Accepted: 1 September 2020 © The Author(s) 2020
Summary Background In the surgical treatment of esophageal cancer, complete tumor resection is the most important factor and determines long-term survival. With an increase in robotic expertise in other fields of surgery, robotic-assisted minimally invasive esophagectomy (RAMIE) was born. Currently, there is a lack of convincing data on the extent of expected benefits (perioperative and oncologic outcomes and/or quality of life). Some evidence exists that patients’ overall quality of life and physical function improves, with less fatigue and pain 3 months after surgery. We aimed to review the available literature regarding robotic esophagectomy, compare perioperative, oncologic, and quality of life outcomes with open and minimally invasive approaches, and give a brief overview of our standardized four-arm RAMIE technique and explore future directions. Methods A Medline (PubMed) search was conducted including the following key words: esophagectomy, minimally invasive esophagectomy, robotic esophagectomy, Ivor Lewis and McKeown. We present the history, different techniques used, outcomes, and the standardization of robotic esophagectomy. Results Robotic esophagectomy offers a steeper learning curve with fewer complications but comparable oncological results compared to conventional minimally invasive esophagectomy. Conclusions Available studies suggest that RAMIE is associated with benefits regarding length of stay, Dr. med. J.-N. Kersebaum · Dr. med. T. Möller · Prof. Dr. med. T. Becker · Prof. Dr. med. J.-H. Egberts () Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany [email protected]
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clinical outcomes, and quality of life—if patients are treated in an experienced center with a standardized technique for robotic esophagectomy—making it a potentially beneficial tool in the treatment of esophageal cancer. However, center-wide standardization and prospective data collection will be a necessity to prove superiority of robotic esophagectomy. Keywords RAMIE · MIE · Learning curve · Standardization · da Vinci
Introduction In the surgical treatment of esophageal cancer, complete tumor resection is the most important factor and determines long-term survival [1, 2]. Unfortunately, less than 50% of patients initially present with local disease [3], which is suitable for resection [4]. Resection is associated with considerable morbidity and mortality, with complication rates ranging from 26–41% and perioperative mortality up to 10% when performed in a conventional open manner, but 5-year survival rates increase to up to 40% in patients who successfully undergo curative surgery [5]. The surgical approach depends upon many factors, w
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