Comparing Robotic Surgery to Open Esophagectomies

By Sara Bondell - December 30, 2020

Esophageal cancer has one of the lowest five-year survival rates among cancer patients in the U.S.: about 19%. Despite advances in treatments, surgery remains the only definitive option for a cure.

However, an esophagectomy, or complete removal of the esophagus, is a challenging and risky procedure. The development of minimally invasive surgery, especially robotic-assisted minimally invasive esophagectomies (RAMIE), has transformed esophagus surgery over the past decades.

Gastrointestinal surgeons at Moffitt Cancer Center have been using RAMIE since 2010, gaining expertise and steady improvement over the years. It is now being used more and more across the country, and as result, Moffitt physicians took a big-picture look into the technique to better compare these outcomes to open surgery.

The study, published in Annals of Surgery, is the largest reported RAMIE series in the world to date. It retrospectively reviewed 350 patients who underwent RAMIE between 2010 and 2019, and found reduced lengths of hospital stay and need for re-operative surgery.

Patients who underwent RAMIE stayed in the hospital nine days on average, compared to 10 days for those who had open surgery. RAMIE patients also had a 2.3% re-operative rate compared to 12.2% for open surgery patients.

“Moreover, with the robotic techniques, we are able to keep incisions small, reducing postoperative pain leading to an expeditious recovery with very good oncologic outcomes,” said Dr. David Pointer, a gastrointestinal surgeon and lead co-author of the study.

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"Moreover, with the robotic techniques, we are able to keep incisions small, reducing postoperative pain leading to an expeditious recovery with very good oncologic outcomes."

- Dr. David Pointer, a gastrointestinal surgeon and lead co-author of the study

The robotic platform also provides a high-definition, 3D view of the operative field and advantages in manipulating surgical instruments.

Dr. Jose Pimiento, a gastrointestinal surgeon and lead co-author of the study
Dr. Jose Pimiento, a gastrointestinal surgeon and lead co-author of the study

“This means we are able to complete the operation in the same technical fashion as a traditional open technique, but without the pain and potential complications of larger incisions,” said Dr. Jose Pimiento, a gastrointestinal surgeon and lead co-author of the study.

RAMIE did show increased operative time and pulmonary embolism rates; however, this did not translate into a difference in survival compared with open surgery. Ultimately, the study showed there are benefits of RAMIE for both patients and surgeons.

“Given the size of our series, we were able to set the benchmark for perioperative and oncologic outcomes in RAMIE,” said Pointer. “Through our propensity-score matched analysis, we also showed that RAMIE exhibits comparative oncologic outcomes when compared to contemporary open approaches.”

Patients who are in good physical shape, haven’t had any previous extensive abdominal or chest surgery, and don’t have preexisting cardiac or pulmonary issues are candidates for RAMIE. They also must be able to tolerate preoperative treatment if necessary.

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