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Page 8 of 16 Hasson et al. Mini-invasive Surg 2020;4:46 I http://dx.doi.org/10.20517/2574-1225.2020.10

Table 4. The DHMC experience
Patient demographics Robotic esophagectomy, n = 40
Age, Mean (SD) 63.3 (8.6)
Male, (%) 36 (90.0)
Pack years, Mean (SD) 46.5 (38.5)
Smoking status, (%)
Current 6 (15.0)
Former 24 (60.0)
Never 10 (25.0)
Alcohol status, (%)
None 9 (22.5)
Current use 1 19 (47.5)
Prior use 1 2 (5.0)
Prior heavy use 2 10 (25.0)
Induction therapy, (%) 33 (82.5)
Operative time, mins, Mean (SD) 512.7 (70.2)
Length of stay, days, Median (range) 9 (5-38)
Complications , (%)
3
Anastomotic Leak 4 6 (15.0)
Pneumonia 4 (10.0)
Atrial fibrillation 5 6 (15.0)
Chyle leak 6 4 (10.0)
30-day mortality, (%) 0
1 2 3
≤ 7 drinks per week for females, ≤ 14 drinks per week for males; > 7 drinks per week for females, > 14 drinks per week for males; within
5
4
6
30-days of index procedure; requiring surgical intervention; requiring treatment; requiring drainage/medical treatment only. All
esophagectomies were performed using either an Ivor Lewis or McKeown approach with an EEA stapler for the anastomoses in the chest
and a combined stapled/handsewn approach for the neck anastomoses, respectively. Esophageal cancer was the indication for all of the
esophagectomies and all patients received neoadjuvant chemoradiation with a cisplatin doublet and 54 Gy. The TNM staging ranged
from T2N0M0 to T3N2M0. The procedure time was averaged between one senior surgeon (≥ 10 years of experience) and one junior
surgeon (< 2 years of experience). Anastomotic leaks were addressed surgically by either stent placement or repair of the anastomosis
for Ivor Lewis complications and washout of the neck for McKeown complications. DHMC: Dartmouth Hitchcock Medical Center; EEA:
end-to-end anastomoses; TNM: Tumor, Node, Metastasis
number of studies presented is large, the number of experiences has also varied between the different
[62]
types of esophagectomy. Detailing the IL experience, Cerfolio et al. originally detailed the outcomes
of 22 patients who underwent robotic-assisted IL esophagectomy (also known as RAILE; note: for these
cases, the abdominal phase was performed in laparoscopic fashion). A two-layer handsewn anastomosis
was fashioned for 16 patients. Morbidity was minimal, 30-day mortality was 0%, and they ultimately
[62]
concluded that RAILE was a safe and oncologically sound procedure . Since that time, many more have
[82]
reported on their experience performing robotic IL esophagectomy [74-81] and more recently, Nora et al.
reviewed outcomes of RAILE. When completed by an experienced surgeon, RAILE has comparable
times to esophagectomies performed via minimally invasive approaches [28,83] . RAILE demonstrated fewer
complications (wound, pulmonary, cardiovascular, and overall) compared with open IL esophagectomies
and duration of hospital stay was significantly lower in the RAILE versus open cohort. However, as
[82]
expected, RAILE resulted in increased pulmonary complications compared to RATE . Conversely, RATE
demonstrated increased rates of major complications compared to RAILE including an increased risk
of anastomotic leak, higher incidence of recurrent laryngeal nerve injuries, wound complications, and
[82]
aspiration .
[41]
Similar to RAILE, there were initially few reports of RATE experience in the literature. Dunn et al. were
one of the first groups to report their outcomes in 40 patients, of which 17 had undergone neoadjuvant
treatment. The operating time had a median of 311 min (range: 226-491 min), and the conversion rate was
[41]
12.5% . The morbidity rate of their cohort was high, and complications included pneumonia (20%), pleural
effusion (45%), anastomotic leak (25%), recurrent laryngeal nerve injury (35%), and anastomotic stricture