PURPOSE: Ivor Lewis Esophagectomy for esophageal cancer is associated with significant morbidity and mortality. The complications are reported to be higher after induction chemo and radiation therapy. We reasoned that a robotic video-assisted approach may be less invasive. We assessed the morbidity and mortality and survival of patients who underwent robotic-assisted Ivor Lewis Esophagectomy.
METHODS: Between 1/04 and 1/07 28 patients underwent robotic-assisted Ivor Lewis Esophagectomy with intrathoracic esophagogastrostomy (19 men, 9 women, age range 37-77).
RESULTS: 11 patients had pre-operative neoadjuvant therapy. Median operative time was 9 hours (range 8-17 hours). Esophagogastrostomy was performed in the right chest above the azygous vein (21 stapled, 7 sutured). There were 8 nonemergent conversions to a thoracotomy due to technical difficulty with the anastomosis. There were 20 ACA, 5 SCCA, 1 high grade dysplasia, 1 poorly differentiated ca, 1 carcinoma in situ. Median hospitalization was 11 days (range 8-60 days). There was 1 anastomotic leak (3%) in a patient who had received induction therapy. Complications included 4 atrial fibrillation, 2 pulmonary embolism, 1 gastric staple line dehiscence > 30 days, 1 ileus, 1 respiratory failure, 1 CHF, 1 reversible renal failure, 1 C-Diff colitis. The majority of complications were seen in patients who received induction therapy. There was one death (3%). Follow up was complete in 26 patients (93%). At the time of follow up, 6 patients (23%) had required dilation of the esophagogastrostomy. 19 (73%) were alive (4 alive with distant mets). 3 patient died of their cancer (11%) and 5 died of other causes (19%).
CONCLUSION: Robotic-assisted Ivor Lewis esophagectomy for esophageal cancer is feasable and may be better suited to patients who undergo induction chemo-radiation therapy.
CLINICAL IMPLICATIONS: Greater experience and longer followup are necessary to fully assess the role of robotics in patients with esophageal cancer.
DISCLOSURE: Farid Gharagozloo, No Financial Disclosure Information; No Product/Research Disclosure Information