Application of robot-assisted minimally invasive Ivor Lewis esophagectomy for esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yajie , HAN Yu , XIANG Jie ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, P.R.China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Robotic surgery; Ivor Lewis; esophageal cancer; esophagogastric anastomosis

DOI：

10.7507/1007-4848.201804080

Video：

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Objective To evaluate the effects of robot-assisted Ivor Lewis esophagectomy (RAILE) in surgical treatment of esophageal cancer. Methods We retrospectively analyzed the clinical data of 70 patients diagnosed with mid-lower esophageal cancer undergoing RAILE in the Department of Thoracic Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University between May 2015 and April 2018. There were 54 males and 16 females at average age of 62.0±7.6 years. Forty patients underwent circular end-to-end stapled intrathoracic anastomosis and 30 had a double-layered, completely hand-sewn intrathoracic anastomosis. Results The mean operating time was 308.7±60.6 minutes. And blood loss was 190.0±95.1 ml. There were 2 patients who underwent conversion to thoracotomy. There was no in-hospital and 30-day mortality. Overall complications were observed in 24 patients (34.3%), of whom 6 patients (8.6%) had anastomotic leakage. The median length of hospitalization was 9.0 (interquartile range, IQR, 5.0) days. The mean tumor size was 3.2±1.5 cm, and R0 resection was achieved in all patients. The mean number of totally dissected lymph nodes was 19.3±8.7. Conclusion RAILE is safe and technically feasible with satisfactory perioperative outcomes.

Citation： ZHANG Yajie, HAN Yu, XIANG Jie, LI Hecheng. Application of robot-assisted minimally invasive Ivor Lewis esophagectomy for esophageal cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 735-741. doi: 10.7507/1007-4848.201804080 Copy

1.	贺宇彤, 陈万青, 赫捷, 等. 2013年中国食管癌发病和死亡估计. 中华肿瘤杂志, 2017, 39(4): 315-320.
2.	Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet, 2013, 381(9864): 400-412.
3.	Hsu PK, Huang CS, Wu YC, et al. Open versus thoracoscopic esophagectomy in patients with esophageal squamous cell carcinoma. World J Surg, 2014, 38(2): 402-409.
4.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
5.	Qureshi YA, Dawas KI, Mughal M, et al. Minimally invasive and robotic esophagectomy: Evolution and evidence. J Surg Oncol, 2016, 114(6): 731-735.
6.	Bizekis C, Kent MS, Luketich JD, et al. Initial experience with minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg, 2006, 82(2): 402-406.
7.	Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg, 2003, 138(7): 777-784.
8.	Wee JO, Bravo-Iñiguez CE, Jaklitsch MT. Early experience of robot-assisted esophagectomy with circular end-to-end stapled anastomosis. Ann Thorac Surg, 2016, 102(1): 253-259.
9.	Sarkaria IS, Rizk NP, Finley DJ, et al. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development. Eur J Cardiothorac Surg, 2013, 43(5): e107-e115.
10.	Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol, 2017, 12(1): 36-42.
11.	Kernstine KH. The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience. Surg Endosc, 2008, 22(9): 2102.
12.	van Hillegersberg R, Boone J, Draaisma WA, et al. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc, 2006, 20(9): 1435-1439.
13.	Galvani CA, Gorodner MV, Moser F, et al. Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc, 2008, 22(1): 188-195.
14.	Dunn DH, Johnson EM, Morphew JA, et al. Robot-assisted transhiatal esophagectomy: a 3-year single-center experience. Dis Esophagus, 2013, 26(2): 159-166.
15.	Hodari A, Park KU, Lace B, et al. Robot-assisted minimally invasive Ivor Lewis esophagectomy with real-time perfusion assessment. Ann Thorac Surg, 2015, 100(3): 947-952.
16.	Bongiolatti S, Annecchiarico M, Di Marino M, et al. Robot-sewn Ivor-Lewis anastomosis: preliminary experience and technical details. Int J Med Robot, 2016, 12(3): 421-426.
17.	Ruurda JP, van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive esophagectomy for esophageal cancer: A systematic review. J Surg Oncol, 2015, 112(3): 257-265.
18.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
19.	Kassis ES, Kosinski AS, Ross P Jr, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
20.	Noble F, Kelly JJ, Bailey IS, et al. A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy. Dis Esophagus, 2013, 26(3): 263-271.
21.	Guo W, Ma L, Zhang Y, et al. Totally minimally invasive Ivor-Lewis esophagectomy with single-utility incision video-assisted thoracoscopic surgery for treatment of mid-lower esophageal cancer. Dis Esophagus, 2016, 29(2): 139-145.
22.	Park S, Hwang Y, Lee HJ, et al. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis, 2016, 8(10): 2853-2861.
23.	Sarkaria IS, Rizk NP, Grosser R, et al. Attaining proficiency in robotic-assisted minimally invasive esophagectomy while maximizing safety during procedure development. Innovations (Phila), 2016, 11(4): 268-273.
24.	Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis. J Thorac Cardiovasc Surg, 2013, 145(1): 90-96.
25.	Tsurumaru M, Kajiyama Y, Udagawa H, et al. Outcomes of extended lymph node dissection for squamous cell carcinoma of the thoracic esophagus. Ann Thorac Cardiovasc Surg, 2001, 7(6): 325-329.
26.	Tan Z, Ma G, Zhao J, et al. Impact of thoracic recurrent laryngeal node dissection: 508 patients with tri-incisional esophagectomy. J Gastrointest Surg, 2014, 18(1): 187-193.
27.	Chao YK, Hsieh MJ, Liu YH, et al. Lymph node evaluation in robot-assisted versus video-assisted thoracoscopic esophagectomy for esophageal squamous cell carcinoma: a propensity-matched analysis. World J Surg, 2018, 42(2): 590-598.
28.	张晓彬, 郭旭峰, 李志刚, 等. 达芬奇机器人手术系统辅助与胸腹腔镜联合辅助食管癌根治术的疗效分析. 中华消化外科杂志, 2017, 16(8): 844-849.

1. 贺宇彤, 陈万青, 赫捷, 等. 2013年中国食管癌发病和死亡估计. 中华肿瘤杂志, 2017, 39(4): 315-320.
2. Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet, 2013, 381(9864): 400-412.
3. Hsu PK, Huang CS, Wu YC, et al. Open versus thoracoscopic esophagectomy in patients with esophageal squamous cell carcinoma. World J Surg, 2014, 38(2): 402-409.
4. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
5. Qureshi YA, Dawas KI, Mughal M, et al. Minimally invasive and robotic esophagectomy: Evolution and evidence. J Surg Oncol, 2016, 114(6): 731-735.
6. Bizekis C, Kent MS, Luketich JD, et al. Initial experience with minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg, 2006, 82(2): 402-406.
7. Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg, 2003, 138(7): 777-784.
8. Wee JO, Bravo-Iñiguez CE, Jaklitsch MT. Early experience of robot-assisted esophagectomy with circular end-to-end stapled anastomosis. Ann Thorac Surg, 2016, 102(1): 253-259.
9. Sarkaria IS, Rizk NP, Finley DJ, et al. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development. Eur J Cardiothorac Surg, 2013, 43(5): e107-e115.
10. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol, 2017, 12(1): 36-42.
11. Kernstine KH. The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience. Surg Endosc, 2008, 22(9): 2102.
12. van Hillegersberg R, Boone J, Draaisma WA, et al. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc, 2006, 20(9): 1435-1439.
13. Galvani CA, Gorodner MV, Moser F, et al. Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc, 2008, 22(1): 188-195.
14. Dunn DH, Johnson EM, Morphew JA, et al. Robot-assisted transhiatal esophagectomy: a 3-year single-center experience. Dis Esophagus, 2013, 26(2): 159-166.
15. Hodari A, Park KU, Lace B, et al. Robot-assisted minimally invasive Ivor Lewis esophagectomy with real-time perfusion assessment. Ann Thorac Surg, 2015, 100(3): 947-952.
16. Bongiolatti S, Annecchiarico M, Di Marino M, et al. Robot-sewn Ivor-Lewis anastomosis: preliminary experience and technical details. Int J Med Robot, 2016, 12(3): 421-426.
17. Ruurda JP, van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive esophagectomy for esophageal cancer: A systematic review. J Surg Oncol, 2015, 112(3): 257-265.
18. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
19. Kassis ES, Kosinski AS, Ross P Jr, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
20. Noble F, Kelly JJ, Bailey IS, et al. A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy. Dis Esophagus, 2013, 26(3): 263-271.
21. Guo W, Ma L, Zhang Y, et al. Totally minimally invasive Ivor-Lewis esophagectomy with single-utility incision video-assisted thoracoscopic surgery for treatment of mid-lower esophageal cancer. Dis Esophagus, 2016, 29(2): 139-145.
22. Park S, Hwang Y, Lee HJ, et al. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis, 2016, 8(10): 2853-2861.
23. Sarkaria IS, Rizk NP, Grosser R, et al. Attaining proficiency in robotic-assisted minimally invasive esophagectomy while maximizing safety during procedure development. Innovations (Phila), 2016, 11(4): 268-273.
24. Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis. J Thorac Cardiovasc Surg, 2013, 145(1): 90-96.
25. Tsurumaru M, Kajiyama Y, Udagawa H, et al. Outcomes of extended lymph node dissection for squamous cell carcinoma of the thoracic esophagus. Ann Thorac Cardiovasc Surg, 2001, 7(6): 325-329.
26. Tan Z, Ma G, Zhao J, et al. Impact of thoracic recurrent laryngeal node dissection: 508 patients with tri-incisional esophagectomy. J Gastrointest Surg, 2014, 18(1): 187-193.
27. Chao YK, Hsieh MJ, Liu YH, et al. Lymph node evaluation in robot-assisted versus video-assisted thoracoscopic esophagectomy for esophageal squamous cell carcinoma: a propensity-matched analysis. World J Surg, 2018, 42(2): 590-598.
28. 张晓彬, 郭旭峰, 李志刚, 等. 达芬奇机器人手术系统辅助与胸腹腔镜联合辅助食管癌根治术的疗效分析. 中华消化外科杂志, 2017, 16(8): 844-849.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of robot-assisted minimally invasive Ivor Lewis esophagectomy for esophageal cancer

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