Robotic esophagectomy with outermost layer-oriented dissection for esophageal cancer: technical aspects and a retrospective review of a single-institution database

Masaya Nakauchi; Susumu Shibasaki; Kazumitsu Suzuki; Akiko Serizawa; Shingo Akimoto; Tsuyoshi Tanaka; Kazuki Inaba; Ichiro Uyama; Koichi Suda

doi:10.1007/s00464-023-10437-8

Robotic esophagectomy with outermost layer-oriented dissection for esophageal cancer: technical aspects and a retrospective review of a single-institution database

Surg Endosc. 2023 Nov;37(11):8879-8891. doi: 10.1007/s00464-023-10437-8. Epub 2023 Sep 28.

Authors

Affiliations

¹ Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan.
² Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
³ Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan.
⁴ Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. ko-suda@nifty.com.
⁵ Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan. ko-suda@nifty.com.

PMID: 37770607
DOI: 10.1007/s00464-023-10437-8

Abstract

Background: Systematic lymph node dissection in patients with gastric cancer could be sufficiently and reproducibly achieved along the outermost layer of the autonomic nerves and similar concept has been extensively used for robotic esophagectomy (RE) since 2018. This study aimed to determine the surgical and oncological safety of RE using the outermost layer-oriented approach for esophageal cancer (EC).

Methods: Sixty-six patients who underwent RE with total mediastinal lymphadenectomy for primary EC between April 2018 and December 2021 were retrospectively reviewed. All underwent the outermost layer-oriented approach with intraoperative nerve monitoring (IONM). Postoperative complications within 30 days were analyzed.

Results: Among the patients, 51 (77.3%) were male. The median age was 64 years, and the body mass index was 21.8 kg/m². Furthermore, 58 (87.9%) patients had squamous cell carcinoma and eight (12.1%) patients had adenocarcinoma. Clinical stages I, II, and III were seen in 23 (34.8%), 23 (34.8%), and 16 (24.2%) patients, respectively. Thirty-four (51.5%) patients received preoperative treatment. No patient shifted to conventional thoracoscopic or open procedure intraoperatively. The median operative time was 716 min with 119 mL of blood loss. Additionally, 64 (97%) patients underwent R0 resection. The morbidity rates based on Clavien-Dindo grades ≥ II and ≥ IIIa were 30.3% and 10.6%, respectively, within 30 postoperative days. None died within 90 days postoperatively. Three (4.5%) patients exhibited recurrent laryngeal nerve (RLN) palsy (CD grade ≥ II). The sensitivity and specificity of IONM for RLN palsy were 50% and 98.3% at the right RLN and 33.3% and 98.0% at the left RLN, respectively.

Conclusion: RE with the outermost layer-oriented approach can provide safe short-term outcomes.

Keywords: Esophageal neoplasms; Minimally invasive surgical procedures; Morbidity; Robotic surgical procedures.

MeSH terms

Esophageal Neoplasms* / pathology
Esophagectomy / methods
Female
Humans
Lymph Node Excision / methods
Male
Middle Aged
Paralysis
Recurrent Laryngeal Nerve / pathology
Retrospective Studies
Robotic Surgical Procedures* / methods