Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;37(6):4466-4477.
doi: 10.1007/s00464-023-09911-0. Epub 2023 Feb 17.

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

Jin-On Jung #  1 , Eline M de Groot #  2 , B Feike Kingma  2 , Benjamin Babic  1 , Jelle P Ruurda  2 , Peter P Grimminger  3 , Jens P Hölzen  4 , Yin-Kai Chao  5 , Jan W Haveman  6 , Marc J van Det  7 , Philippe Rouanet  8 , Frank Benedix  9 , Hecheng Li  10 , Inderpal Sarkaria  11 , Mark I van Berge Henegouwen  12 , Gijs I van Boxel  13 , Philip Chiu  14 , Jan-Hendrik Egberts  15 , Rubens Sallum  16 , Arul Immanuel  17 , Paul Turner  18 , Donald E Low  19 , Michal Hubka  19 , Daniel Perez  20 , Paolo Strignano  21 , Matthias Biebl  22 , M Asif Chaudry  23 , Christiane J Bruns  1 , Richard van Hillegersberg #  2 , Hans F Fuchs #  24 ; UGIRA Study Group
Affiliations

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

Jin-On Jung et al. Surg Endosc. 2023 Jun.

Abstract

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.

Keywords: Complications; Hybrid laparoscopic approach; Perioperative outcome; Propensity-score matching; RAMIE; Robot-assisted minimally invasive esophagectomy.

PubMed Disclaimer

Conflict of interest statement

Drs. Richard van Hillegersberg, Peter P Grimminger and Jelle P Ruurda are consultants for Medtronic and proctors for Intuitive Surgical. Drs. Daniel Perez and Marc J van Det are proctors for Intuitive Surgical. Dr. Mark I van Berge Henegouwen is consultant for Mylan, Johnson & Johnson, Alesi Surgical, B. Braun, Medtronic, and received unrestricted research grants from Stryker (all fees paid to institution). Dr. Yin-Kai Chao is consultant for Intuitive Surgical and received a research grant from Intuitive Surgical. Drs. Christiane J Bruns and Hans F Fuchs are both consultants for Medtronic and received an educational grant from Intuitive Surgical. Drs. Jin-On Jung, Eline M de Groot, B Feike Kingma, Benjamin Babic, Jens P Hölzen, Jan W Haveman, Philippe Rouanet, Frank Benedix, Hecheng Li, Inderpal Sarkaria, Gijs I van Boxel, Philip Chiu, Jan-Hendrik Egberts, Rubens Sallum, Arul Immanuel, Paul Turner, Donald E Low, Michal Hubka, Paolo Strignano, Matthias Biebl and M Asif Chaudry have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Overlap of data points with propensity-score plotted against data availability (see A). The augmentation of the PSM threshold does not necessarily lead to higher case numbers which is why a threshold of 0.001 was chosen with a retained proportion of > 80% (see B)
Fig. 2
Fig. 2
Box plots for continuous outcome parameters: Significant differences were found for length of stay on ICU (see C, p = 0.0005) and for total length of in-hospital stay (see D, p < 0.0001). Box plots for A total intraoperative blood loss, B total operational time, C length of stay on ICU, D length of in-hospital stay, E total lymphnode yield, F number of positive lymphnodes. ICU intensive care unit
Fig. 3
Fig. 3
Bar graphs of binary outcome parameters: Significant differences were found for complications according to Clavien Dindo grade 3a or higher (p < 0.001) and anastomotic leakage (p = 0.001). RAMIE robot-assisted minimally invasive esophagectomy
See this image and copyright information in PMC

References

    1. Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090–1098. doi: 10.1016/S1470-2045(15)00040-6. - DOI - PubMed
    1. Schröder W, Gisbertz SS, Voeten DM, Gutschow CA, Fuchs HF, van Berge Henegouwen MI. Surgical therapy of esophageal adenocarcinoma–current standards and future perspectives. Cancers (Basel) 2021;13(22):5834. doi: 10.3390/cancers13225834. - DOI - PMC - PubMed
    1. Babic B, Schiffmann LM, Schröder W, Bruns CJ, Fuchs HF. Evidence in minimally invasive oncological surgery of the esophagus. Chirurg. 2021;92(4):299–303. doi: 10.1007/s00104-020-01337-x. - DOI - PubMed
    1. Haverkamp L, Seesing MFJ, Ruurda JP, Boone J, van Hillegersberg R. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus. 2017;30(1):1–7. doi: 10.1111/dote.12480. - DOI - PubMed
    1. Straatman J, Van Der Wielen N, Cuesta MA, et al. Minimally invasive versus open esophageal resection. Ann Surg. 2017;266(2):232–236. doi: 10.1097/SLA.0000000000002171. - DOI - PubMed

Publication types

MeSH terms