Does the Robot Make a Difference? Oncologic Resection in Laparosopic Versus Robot Assisted Transhiatal Esophagectomy

Jeffrey R Watkins, MD, D Rohan Jeyarajah, MD. Methodist Dallas Medical Center

Introduction: The aim of this study is to examine the perioperative oncologic outcomes of patients undergoing laparoscopic versus robot-assisted transhiatal esophagectomy. As robotic surgery continues to increase in volume, little is known about robotic oncologic outcomes compared to traditional methods.

Methods and Procedures: We identified 36 consecutive patients who underwent laparoscopic and robot-assisted transhiatal esophagectomy for malignant disease over a three-year period. Patients with benign disease or who had a planned open procedure were excluded. Eighteen patients underwent robotic-assisted transhiatal esophagectomy with cervical anastomosis while 18 patients underwent laparoscopic transhiatal esophagectomy. All procedures were performed by a single foregut and thoracic surgeon. Patient charts were reviewed and all relevant data were extracted and evaluated. Statistical analysis was performed.

Results: Lymph node yield for both laparoscopic and robot-assisted were similar at 13.9 and 14.28 respectively (p = 0.90). Ninety four percent of each group underwent R0 margins while only 1 patient from each modality had microscopic positive margins on pathology. The type of malignancy was similar for each group with 15 patients in the laparoscopic group undergoing treatment for adenocarcinoma versus 14 for the robot group (p = 0.99). All of the robot patients underwent neoadjuvant chemoradiation while 77% underwent neoadjuvant therapy in the laparoscopy group (p = 0.23). Clinical and pathologic staging was similar in each group. There was one mortality after laparoscopic surgery in a cirrhotic patient and no mortalities amongst the robot patients (p = 0.99). One patient from each group experienced an anastomotic leak but neither required any further intervention. Patient demographics were similar between both groups with no significant difference in age, gender or BMI.

Conclusions: Laparoscopic and robot-assisted trans-hiatal esophagectomy yield similar perioperative oncologic results including lymph node yield and disease-free margins. In the transition from laparoscopic surgery, robotic surgery should be considered non-inferior oncologically when compared to laparoscopy.