Lymph Node Evaluation in Robot-Assisted Versus Video-Assisted Thoracoscopic Esophagectomy for Esophageal Squamous Cell Carcinoma: A Propensity-Matched Analysis

Objective Radical lymph node dissection (LND) along the bilateral recurrent laryngeal nerve (RLN) is a surgically challenging procedure with a high rate of morbidity. Here, we assessed in a retrospective manner the adequacy of LND along the RLN performed with robot-assisted thoracoscopic esophagecto...

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Bibliographic Details
Published in:	World journal of surgery 2018-02, Vol.42 (2), p.590-598
Main Authors:	Chao, Yin-Kai, Hsieh, Ming-Ju, Liu, Yun-Hen, Liu, Hui-Ping
Format:	Article
Language:	eng
Subjects:	Abdominal Surgery Adequacy Aged Biopsy Blood Loss, Surgical Blood transfusion Carcinoma, Squamous Cell - surgery Cardiac Surgery Complications Esophageal cancer Esophageal Neoplasms - surgery Esophageal Squamous Cell Carcinoma Esophagectomy - adverse effects Esophagectomy - methods Esophagus Female Gastrointestinal surgery General Surgery Humans Lymph Lymph Node Excision - adverse effects Lymph Node Excision - methods Lymph nodes Lymph Nodes - pathology Lymphatic system Male Medicine Medicine & Public Health Middle Aged Morbidity Original Scientific Report with Video Ostomy Paralysis Patients Postoperative Complications - diagnosis Propensity Score Recurrent Laryngeal Nerve - surgery Retrospective Studies Robotic surgery Robotic Surgical Procedures - adverse effects Robotic Surgical Procedures - methods Robots Squamous cell carcinoma Surgery Thoracic Surgery Thoracic Surgery, Video-Assisted - adverse effects Thoracic Surgery, Video-Assisted - methods Vascular Surgery Vocal Cord Paralysis - diagnosis
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Summary:	Objective Radical lymph node dissection (LND) along the bilateral recurrent laryngeal nerve (RLN) is a surgically challenging procedure with a high rate of morbidity. Here, we assessed in a retrospective manner the adequacy of LND along the RLN performed with robot-assisted thoracoscopic esophagectomy (RATE) versus video-assisted thoracoscopic esophagectomy (VATE) in patients with esophageal squamous cell carcinoma (ESCC). Methods This was a single-center, retrospective, propensity-matched study. ESCC patients who underwent McKeown esophagectomy and bilateral RLN LND with a minimally invasive approach were divided into two groups according to the use of robot-assisted surgery or not (RATE vs VATE, respectively). Using propensity score matching, 34 balanced matched pairs were identified. The number of dissected nodes as well as the rates of RLN palsy and perioperative complications served as the main outcome measures. Results No conversion to open thoracotomy occurred in either group. Intraoperative blood loss and the need of blood transfusions did not show significant intergroup differences. The mean number of dissected nodes was similar in the two study groups, the only exception being the left RLN area. Specifically, the mean number of nodes removed from this region was 5.32 in the RATE group and 3.38 in patients who received VATE ( p = 0.007). Notably, the RATE and VATE groups did not differ significantly with regard to rates of both RLN palsy (20.6 vs 29.4%, respectively, p = 0.401) and pulmonary complications (5.9 vs 17.6%, respectively, p = 0.259). Conclusions Compared with VATE, RATE resulted in a higher lymph node yield along the left RLN without increasing morbidity.
ISSN:	0364-2313 1432-2323