Robot-assisted Minimally Invasive Thoracolaparoscopic Esophagectomy Versus Open Transthoracic Esophagectomy for Resectable Esophageal Cancer: A Randomized Controlled Trial

Pieter C. van der Sluis, Sylvia van der Horst, Anne M. May, Carlo Schippers, Lodewijk A.A. Brosens, Hans C.A. Joore, Christiaan C. Kroese, Nadia Haj Mohammad, Stella Mook, Frank P. Vleggaar, Inne H.M. Borel Rinkes, Jelle P. Ruurda, Richard van Hillegersberg

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

BACKGROUND: The standard curative treatment for patients with esophageal cancer is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE). Robot-assisted minimally invasive thoracolaparoscopic esophagectomy (RAMIE) may reduce complications. METHODS: A single-center randomized controlled trial was conducted, assigning 112 patients with resectable intrathoracic esophageal cancer to either RAMIE or OTE. The primary endpoint was the occurrence of overall surgery-related postoperative complications (modified Clavien-Dindo classification grade 2-5). RESULTS: Overall surgery-related postoperative complications occurred less frequently after RAMIE (59%) compared to OTE (80%) [risk ratio with RAMIE (RR) 0.74; 95% confidence interval (CI), 0.57-0.96; P = 0.02]. RAMIE resulted in less median blood loss (400 vs 568 mL, P <0.001), a lower percentage of pulmonary complications (RR 0.54; 95% CI, 0.34-0.85; P = 0.005) and cardiac complications (RR 0.47; 95% CI, 0.27-0.83; P = 0.006) and lower mean postoperative pain (visual analog scale, 1.86 vs 2.62; P < 0.001) compared to OTE. Functional recovery at postoperative day 14 was better in the RAMIE group [RR 1.48 (95% CI, 1.03-2.13; P = 0.038)] with better quality of life score at discharge [mean difference quality of life score 13.4 (2.0-24.7, p = 0.02)] and 6 weeks postdischarge [mean difference 11.1 quality of life score (1.0-21.1; P = 0.03)]. Short- and long-term oncological outcomes were comparable at a medium follow-up of 40 months. CONCLUSIONS: RAMIE resulted in a lower percentage of overall surgery-related and cardiopulmonary complications with lower postoperative pain, better short-term quality of life, and a better short-term postoperative functional recovery compared to OTE. Oncological outcomes were comparable and in concordance with the highest standards nowadays.

Original languageEnglish
Pages (from-to)621-630
Number of pages10
JournalAnnals of Surgery
Volume269
Issue number4
Early online date2018
DOIs
Publication statusPublished - 1 Apr 2019

Keywords

  • esophageal cancer
  • esophageal carcinoma
  • minimally invasive
  • Minimally invasive esophagectomy
  • robot assisted
  • robot-assisted minimally invasive thoracolaparoscopic esophagectomy

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