Does the Robotic Platform Offer Substantive Benefit for Esophagectomy: A comparative Analysis of Open, Minimally Invasive and Robotic Assisted Procedures
Anna M. Soltys, Michael F. Szwerc, Victor Reis, Kyle M. Langston, PAC, Scott W. Beman, T Daniel Harrison, Richard C. Boorse, Lehigh Valley Health Network, Allentown, PA
OBJECTIVE: The incidence of adenocarcinoma of the esophagus is increasing. Although minimal invasive techniques are gaining increasing popularity, little comparative data exists between open (OE), VATS/Laparoscopic (VL) and robotic assisted (RAL) minimally invasive.
METHODS: This is a single institution retrospective review of all esophagectomies (126) performed for primary malignant tumors of the mid and distal esophagus from January 2005 through April 2013 by either OE (68), VL (32) or RAL (26) techniques. Outcomes for OE were compared to those from VL and RAL combined (MIE group) using t-tests, Mann Whitney U and Fisher €™s Exact tests. Subanalyses then compared outcomes between RAL and VL.
RESULTS: Average patient average age was 66.21 years and 88% were male. The prevalence of induction therapy, preclinical stage and comorbidities did not vary between groups. Relative to OE, MIE was associated with a significant reduction in median hospital length of stay (LOS) (6 days vs. 11 days; p=0.023) without any change in 30-day readmission (22.4% vs. 22.1%; p=1.000) and a trend toward reduction in 30-day mortality was identified (0% vs. 7.5%; p=0.061). Similarly, MIE was associated with fewer complications than OE (5.3% vs. 19.1%, p=0.030 for anastomotic leaks; 12.1% vs. 35.3%, p=0.005 for stricture formation). Comparing outcomes from RAL to those of VL, a significant reduction in median LOS was noted (5 days vs. 7 days, p=0.031).
CONCLUSION: MIE improves procedural-related outcomes for esophagectomy over OE techniques resulting in a significant reduction in LOS, anastomotic leak rates and stricture formation. RAL resulted in the shortest LOS.