Comparison of short-term outcomes between transthoracic and robot-assisted transmediastinal radical surgery for esophageal cancer: a prospective study.

Abstract

BACKGROUND:

The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.

METHODS:

Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.

RESULTS:

Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements).

CONCLUSIONS:

Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.

TRIAL REGISTRATION:

This trial was registered in the UMIN Clinical Trial Registry ( UMIN000017565 14/05/2015).

• Authors: Shuntaro Yoshimura, Kazuhiko Mori, Motonari Ri, Susumu Aikou, Koichi Yagi, Yukinori Yamagata, Masato Nishida, Hiroharu Yamashita, Sachiyo Nomura, Yasuyuki Seto
• Journal: BMC cancer (BMC Cancer) Vol. 21 Issue 1 Pg. 338 (Mar 31 2021) ISSN: 1471-2407 [Electronic] England
• PMID: 33789620 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Esophageal Neoplasms (surgery)
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Robotic Surgical Procedures (methods)
• Robotics (methods)
• Treatment Outcome
• Young Adult