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
. 2024 Jul;31(7):4281-4297.
doi: 10.1245/s10434-024-15148-5. Epub 2024 Mar 13.

Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes

Nikhil Manish Patel  1   2 , Pranav Harshad Patel  1   2 , Kai Tai Derek Yeung  1   3 , David Monk  4 , Borzoueh Mohammadi  4 , Muntzer Mughal  4 , Ricky Harminder Bhogal  1   2 , William Allum  1 , Nima Abbassi-Ghadi  5 , Sacheen Kumar  6   7   8
Affiliations

Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes

Nikhil Manish Patel et al. Ann Surg Oncol. 2024 Jul.

Abstract

Background: Radical esophagectomy for resectable esophageal cancer is a major surgical intervention, associated with considerable postoperative morbidity. The introduction of robotic surgical platforms in esophagectomy may enhance advantages of minimally invasive surgery enabled by laparoscopy and thoracoscopy, including reduced postoperative pain and pulmonary complications. This systematic review aims to assess the clinical and oncological benefits of robot-assisted esophagectomy.

Methods: A systematic literature search of the MEDLINE (PubMed), Embase and Cochrane databases was performed for studies published up to 1 August 2023. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols and was registered in the PROSPERO database (CRD42022370983). Clinical and oncological outcomes data were extracted following full-text review of eligible studies.

Results: A total of 113 studies (n = 14,701 patients, n = 2455 female) were included. The majority of the studies were retrospective in nature (n = 89, 79%), and cohort studies were the most common type of study design (n = 88, 79%). The median number of patients per study was 54. Sixty-three studies reported using a robotic surgical platform for both the abdominal and thoracic phases of the procedure. The weighted mean incidence of postoperative pneumonia was 11%, anastomotic leak 10%, total length of hospitalisation 15.2 days, and a resection margin clear of the tumour was achieved in 95% of cases.

Conclusions: There are numerous reported advantages of robot-assisted surgery for resectable esophageal cancer. A correlation between procedural volume and improvements in outcomes with robotic esophagectomy has also been identified. Multicentre comparative clinical studies are essential to identify the true objective benefit on outcomes compared with conventional surgical approaches before robotic surgery is accepted as standard of practice.

Keywords: Clinical outcomes; Esophageal cancer; Esophagectomy; Lymphadenectomy; Minimally invasive surgery; Oncological outcomes; Perioperative therapy; Robotic surgery.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Forest plot on reported anastomotic leak rate. CI confidence interval
Fig. 1
Fig. 1
Forest plot on reported anastomotic leak rate. CI confidence interval
Fig. 2
Fig. 2
Forest plot on 30 day mortality rate. CI confidence interval
Fig. 3
Fig. 3
Forest plot on 90 day mortality rate. CI confidence interval
Fig. 4
Fig. 4
PRISMA reporting standards. PRISMA preferred reporting items for systematic reviews and meta-analyses
Fig. 5
Fig. 5
Studies published, by country
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. van der Sluis PC, van der Horst S, May AM, et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Ann Surg. 2019;269(4):621–630. doi: 10.1097/SLA.0000000000003031. - DOI - PubMed
    1. Al-Batran S-E, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–1957. doi: 10.1016/S0140-6736(18)32557-1. - DOI - PubMed
    1. van Hagen P, Hulshof MCCM, Lanschot JJB, et al. preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–2084. doi: 10.1056/NEJMoa1112088. - DOI - PubMed
    1. Wang H, Tang H, Fang Y, et al. Morbidity and mortality of patients who underwent minimally invasive esophagectomy after neoadjuvant chemoradiotherapy vs neoadjuvant chemotherapy for locally advanced esophageal squamous cell carcinoma: a randomized clinical trial. JAMA Surg. 2021;156(5):444–451. doi: 10.1001/jamasurg.2021.0133. - DOI - PMC - PubMed
    1. Mehdorn A-S, Möller T, Franke F, et al. Long-term, health-related quality of life after open and robot-assisted ivor-lewis procedures- a propensity score-matched study. J Clin Med. 2020;9(11):3513. doi: 10.3390/jcm9113513. - DOI - PMC - PubMed

Publication types