Farid Gharagozloo, Marc Margolis, Barbara Tempesta, Eric Strother.
Washington Institute Of Thoracic And Cardiovascular Surgery, Washington, DC, USA.
OBJECTIVE:
Ivor Lewis esophagogastrectomy for esophageal cancer is associated with significant morbidity and mortality. The complications are higher after induction chemo/radiation therapy. Although a minimally invasive approach would be preferable, video-assisted techniques have been hampered by difficulty in dissection, and lack of 3D visualization. A robot-assisted approach may overcome these difficulties.
METHODS:
Between 1/04 and 8/07 33 patients underwent robot-assisted Ivor Lewis esophagogastrectomy with a right chest esophagogastrostomy. (24 men, 9 women, age range 37-77)
RESULTS:
13 (39%) patients had preoperative neoadjavent therapy. Median operative time was 9 hrs. (range 8-17 hrs.) Esophagogastrostomy was performed in the right chest above the azygous vein (26 stapled, 7 sutured). There were 8 (24%) nonemergent conversions to a thoracotomy due to technical difficulty with the anastamosis. There were 25 ACA, 5SCCA, 1 high grade dysplasia, 1 poorly differentiated carcinoma, 1 carcinoma in situ. Median hospitalization was 11 days (range 8-60). There was 1 anastamoptic leak (3%) in a patient who had received induction chemo/radition therapy. Complications included A Fib (5), PE (2), Ileus (1), respiratory failure (1), C-diff Colitis (3), CHF (1). There was one death (3%) in the patient who had the esophageal leak and prolonged hospitalization. Follow up was complete in 31 (94%) patients. 24 (77%) were alive. In the 7 patients who had died at the time of followup, 3 died of cancer, and 4 of other causes. There were 4 distant metastases and no local recurrence.
CONCLUSIONS:
Robot-assisted Ivor Lewis esophagogastrectomy is feasible and may represent an alternative to conventional combined celiotomy/thoracotomy approach. Intrathoracic anastamosis remains a challenge. Greater experience and longer followup are necessary to fully assess the role this approach in patients with esophageal cancer.
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