Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma

Abstract

Background: The aim of the study was to compare robot-assisted esophagectomy (RE) with thoracoscopic esophagectomy (TE) for the treatment of esophageal squamous cell carcinoma (ESCC).

Methods: A total of 105 patients who underwent RE (n=62) or TE (n=43) due to ESCC were included in this study. Early postoperative outcomes and long-term survivals between the two groups were compared.

Results: The RE and TE groups were comparable in preoperative clinical characteristics. Total operation times were not significantly different between the two groups (490 minutes in RE vs. 458 minutes in TE; P=0.118). The total number of dissected lymph nodes was significantly greater in the RE group (37.3±17.1 vs. 28.7±11.8; P=0.003), and intergroup differences were significant for numbers of lymph nodes dissected from the upper mediastinum (10.7±9.7 in RE vs. 6.3±9.3 in TE; P=0.032) and the abdomen (12.2±8.7 in RE vs. 7.8±7.1 in TE; P=0.007). Five-year overall survival was not different between the two groups (69% in RE and 59% in TE; P=0.737).

Conclusions: Better quality lymphadenectomy could be achieved in RE although survival benefit was not clear. Prospective randomized studies comparing the RE and TE are necessary.

Keywords: Esophageal neoplasms; robotic surgical procedures; thoracoscopy.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1

Positions of robotic ports in thoracic and abdominal procedure. (A) Photograph of the robot port insertion sites used for the thoracic procedure; (B) photograph of robot port insertion sites used for the abdominal procedure. A, assistant port; C, camera port; R1, port for robot arm 1; R2, port for robot arm 2; R3, port for robot arm 3.

Figure 2

Photograph of left upper mediastinum after robot-assisted dissection along the left recurrent laryngeal nerve. Lymph nodes along the left recurrent laryngeal nerve and aortopulmonary lymph nodes were completely removed. LMB, left main bronchus; LPA, left pulmonary artery; LRLN, left recurrent laryngeal nerve.

Figure 3

Numbers of dissected lymph nodes according to the nodal map. *, represents stations at which nodal number yields were significantly higher in the RE group than in the TE group. RE, robot-assisted esophagectomy; TE, thoracoscopic esophagectomy; RRLN, right recurrent laryngeal nerve lymph node; LRLN, left recurrent laryngeal nerve lymph node.

Figure 4

The 5-year overall survival. Overall survival was 69% in the RE group and 59% in the TE group. However the difference was not statistically significant (P=0.737). RE, robot-assisted esophagectomy; TE, thoracoscopic esophagectomy.

Figure 5

The 5-year freedom from locoregional recurrence. Freedom from locoregional recurrence was 88% in the RE group and 74% in the TE group. However the difference was not statistically significant (P=0.100). RE, robot-assisted esophagectomy; TE, thoracoscopic esophagectomy.