Robot-assisted esophagogastric reconstruction in minimally invasive Ivor Lewis esophagectomy

Abstract

BACKGROUND: Although the incidence of esophagogastric junction cancer has increased considerably in recent years, the application of minimally invasive Ivor Lewis esophagectomy, especially in East Asia, is still much rarer than the McKeown approach. The reconstruction of the alimentary tract is one of the main technical challenges under traditional endoscopy. The robotic surgical system with high-resolution 3D images and multiarticulate instruments may help simplify this procedure. Here, we describe our experience in the gastric tube and esophagogastric anastomosis construction, and the initial clinical results for Ivor Lewis robot-assisted minimally invasive esophagectomy (RAMIE). METHODS: A retrospective study of all patients undergoing Ivor Lewis RAMIE with circular stapled anastomosis at a single institution from December 2016 to June 2018 was performed. Operative and postoperative outcomes were recorded. RESULTS: Twenty-four patients [median age, 63 years (range, 49-77 years)] underwent Ivor Lewis RAMIE during the study period with a four-arm robotic platform. Four patients (16.7%) received neoadjuvant therapy. The median estimated blood loss was 120 mL (range, 50-210 mL). The median operating time was 352.5 min (range, 259-485 min). There was no conversion to an open surgical procedure. Postoperative complications occurred in 3 (12.5%) patients. Complications included pneumonia in two patients (8.3%) and mediastinitis in 1 (4.2%). The median stay in the intensive care unit was 1 d (range, 0-8 d) and the median postoperative hospital stay was 11 d (range, 8-30 d). All patients had an R0 resection. The median number of nodes removed was 19 (range, 11-30) and the median number of positive nodes removed was 1 (range, 0-8). CONCLUSIONS: Our initial results indicate that Ivor Lewis RAMIE may be a safe and feasible alternative to open and endoscopic Ivor Lewis esophagectomy.