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Robotic Esophagectomy Trends and Early Surgical Outcomes: The US Experience.

Publication ,  Conference
Khaitan, PG; Vekstein, AM; Thibault, D; Kosinski, A; Hartwig, MG; Block, M; Gaissert, H; Wolf, AS
Published in: Ann Thorac Surg
March 2023

BACKGROUND: Recent esophagectomy trends were evaluated to describe the shift in surgical approach and outcomes using The Society of Thoracic Surgeons General Thoracic Surgery Database. METHODS: All patients who underwent an esophagectomy with gastric conduit from 2015 to 2019 were identified and analyzed according to original intended approach. After performing volume trend analysis of patients, operative outcomes were evaluated. RESULTS: Among 10,607 patients, esophagectomy was open in 5763 (54.3%), minimally invasive (MIE) in 3524 (33.2%), and robotic (RAMIE) in 1320 (12.4%). Within 5 years, MIE and RAMIE combined rose to majority approach (open from 58% to 42% of annual volume). While MIE and RAMIE were associated with higher rates of anastomotic leak, loss of conduit, pulmonary embolus, and reoperation, R0 resection and harvested number of lymph nodes exceeded those in open approaches. Operative mortality did not differ by approach (3.21% open vs 2.72% MIE vs 2.50% RAMIE; P = .2329). On multivariable analysis, RAMIE was independently associated with higher rate of anastomotic leak compared to open (adjusted odds ratio 1.53, 95% CI 1.14-2.04), while both MIE and RAMIE had lower mean length of stay. Propensity matching of 1320 pairs found a higher risk of anastomotic leak requiring surgery for RAMIE compared with MIE (adjusted odds ratio 1.39, 95% CI 1.01-1.92). CONCLUSIONS: In less than a decade, the dominant surgical approach in The Society of Thoracic Surgeons General Thoracic Surgery Database has become minimally invasive (RAMIE and MIE). While anastomotic leak and reoperation, more common in RAMIE, require a technical solution, these complications have not raised operative mortality. Further studies are needed to address long-term results and oncologic outcome.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2023

Volume

115

Issue

3

Start / End Page

710 / 717

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Robotic Surgical Procedures
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Minimally Invasive Surgical Procedures
  • Lymph Nodes
  • Humans
  • Esophagectomy
  • Esophageal Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
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Khaitan, P. G., Vekstein, A. M., Thibault, D., Kosinski, A., Hartwig, M. G., Block, M., … Wolf, A. S. (2023). Robotic Esophagectomy Trends and Early Surgical Outcomes: The US Experience. In Ann Thorac Surg (Vol. 115, pp. 710–717). Netherlands. https://doi.org/10.1016/j.athoracsur.2022.11.027
Khaitan, Puja Gaur, Andrew M. Vekstein, Dylan Thibault, Andrzej Kosinski, Matthew G. Hartwig, Mark Block, Henning Gaissert, and Andrea S. Wolf. “Robotic Esophagectomy Trends and Early Surgical Outcomes: The US Experience.” In Ann Thorac Surg, 115:710–17, 2023. https://doi.org/10.1016/j.athoracsur.2022.11.027.
Khaitan PG, Vekstein AM, Thibault D, Kosinski A, Hartwig MG, Block M, et al. Robotic Esophagectomy Trends and Early Surgical Outcomes: The US Experience. In: Ann Thorac Surg. 2023. p. 710–7.
Khaitan, Puja Gaur, et al. “Robotic Esophagectomy Trends and Early Surgical Outcomes: The US Experience.Ann Thorac Surg, vol. 115, no. 3, 2023, pp. 710–17. Pubmed, doi:10.1016/j.athoracsur.2022.11.027.
Khaitan PG, Vekstein AM, Thibault D, Kosinski A, Hartwig MG, Block M, Gaissert H, Wolf AS. Robotic Esophagectomy Trends and Early Surgical Outcomes: The US Experience. Ann Thorac Surg. 2023. p. 710–717.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2023

Volume

115

Issue

3

Start / End Page

710 / 717

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Robotic Surgical Procedures
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Minimally Invasive Surgical Procedures
  • Lymph Nodes
  • Humans
  • Esophagectomy
  • Esophageal Neoplasms