Mark J Dudash, MD1, Ryan Erwin, BA2, James Dove, BA1, Marie Hunsinger, RN, BSHS1, Mohsen Shabahang, MD, PhD1, Anthony Petrick, MD1, Tania K Arora, MD1, Joseph A Blansfield, MD1. 1Geisinger Medical Center, 2Temple University School of Medicine
INTRODUCTION: Esophagectomy is the standard treatment for esophageal cancer. Whereas open approaches have the potential for high postoperative complications, minimally invasive esophagectomy (MIE) has been touted to lower postoperative morbidities. MIE includes both robotic and laparoscopic techniques. The aim of this study is to identify trends in MIE and compare outcomes between open, robotic and laparoscopic esophagectomy.
METHODS: Patients undergoing esophagectomy from 2008-2015 entered in the National Inpatient Sample were studied. Patients were divided into open, laparoscopic and robotic groups for comparison.
RESULTS: A total of 6,415 patients were identified, 248 (3.9%) underwent robotic, 334 (5.2%) underwent laparoscopic, and 5,833 (90.9%) underwent open esophagectomy. MIE rose from 3% in 2008 to 12% of all esophagectomies in 2013. MIE rates remained steady from 2013-2015. Robotic MIE increased steadily from 2008-2015. In 2008, essentially all MIE were performed laparoscopically compared to 2013 when the rates were even. From 2013 to 2015, more MIE was performed robotically than laparoscopically.
Demographics between the groups were comparable for age, race, and sex. The mean age for the study group was 62 years. Most of the patients were men (80%). The majority of cases were performed at large hospitals (79%), compared to 8% performed at small hospitals and 13% performed at medium sized hospitals. Urban teaching hospitals accounted for 87.5% of the esophagectomies performed in the study.
Overall complications were lowest for robotic esophagectomy compared to laparoscopic and open (27% vs. 38% vs. 35% respectively, p=0.012). Both pulmonary and gastrointestinal complications were lowest in the robotic cohort. Robotic esophagectomy was also found to have the shortest length of stay (LOS) (9 days vs. 10 (lap) and 11 (open)*, p=<0.0001). Robotic esophagectomy also had the lowest median total charges for the three modalities: $122,926 versus $128,943 for open and $156,676 for laparoscopic (p=0.0002). Mortality for robotic and laparoscopic esophagectomy was comparable and lower than open esophagectomy (1.5% versus 3.9%, p=0.017).
CONCLUSIONS: In recent years rates of MIE have been increasing, with robotic esophagectomy comprising the majority of MIE in 2015. With lower LOS, lower overall complications, lower cost, and mortality, robotic esophagectomy is a safe alternative to laparoscopic and open approaches. Studies will be needed to further evaluate robotic MIE in the future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95538
Program Number: S064
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel