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

Nikhil Manish Patel; Pranav Harshad Patel; Kai Tai Derek Yeung; David Monk; Borzoueh Mohammadi; Muntzer Mughal; Ricky Harminder Bhogal; William Allum; Nima Abbassi-Ghadi; Sacheen Kumar

doi:10.1245/s10434-024-15148-5

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

Ann Surg Oncol. 2024 Mar 13. doi: 10.1245/s10434-024-15148-5. Online ahead of print.

Authors

Nikhil Manish Patel^{1

2}, Pranav Harshad Patel^{1

2}, Kai Tai Derek Yeung^{1

3}, David Monk⁴, Borzoueh Mohammadi⁴, Muntzer Mughal⁴, Ricky Harminder Bhogal^{1

2}, William Allum¹, Nima Abbassi-Ghadi⁵, Sacheen Kumar^{6

7

8}

Affiliations

¹ Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
² The Upper Gastrointestinal Surgical Oncology Research Group, The Institute of Cancer Research, London, UK.
³ Department of Surgery and Cancer, Imperial College London, London, UK.
⁴ Department of Upper Gastrointestinal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic London Hospital, London, UK.
⁵ Department of Upper GI Surgery, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK.
⁶ Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London, UK. Sacheen.kumar@rmh.nhs.uk.
⁷ The Upper Gastrointestinal Surgical Oncology Research Group, The Institute of Cancer Research, London, UK. Sacheen.kumar@rmh.nhs.uk.
⁸ Department of Upper Gastrointestinal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic London Hospital, London, UK. Sacheen.kumar@rmh.nhs.uk.

PMID: 38480565
DOI: 10.1245/s10434-024-15148-5

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.