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MINIMALLY INVASIVE ESOPHAGECTOMY: FROM HYBRID, TO TOTAL MIE, TO ROBOTIC ASSISTED MIE (RAMIE) A SINGLE-CENTER AND SINGLE-SURGEON ANALYSIS
Evangelos Tagkalos*, Edin Hadzijusufovic, Hauke Lange, Peter P. Grimminger
General, Visceral and Transplant Surgery, University Hospital Mainz, Germany, Mainz, Rheinland-Pfalz, Germany
Background:
The incidence of esophageal carcinoma is increasing in the western world and esophageal resection is the essential therapy depending on the tumor stage. Several studies report advantages of minimally invasive esophagectomies (MIE) versus conventional open procedures (OP). The benefits of the use of totally MIE (thoraco- and laparoscopic) or robotic assisted MIE (RAMIE) compared to the hybrid approaches remain unclear.
Patient and Methods:
Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were. 25 were treated with a hybrid MIE (Hybrid), another 25 with a total MIE (T-MIE) and another 25 with a RAMIE. All patients were operated by the same specialized surgeon in our center. Demographic data, duration of hospital stay, intensive care stay (ICU), number of lymph nodes removed and histopathological R-status, as well as total-, thoracic- and abdominal operating times were compared. The complications were assessed according to the Dindo-Clavien classification.
Results:
The overall 30-d and 90-d mortality rate were 0% and 1.33% (1/75) respectively. Total hospital stay (p=0.262), ICU stay (p=0.079), number of resected lymph nodes (p=0.863) and R status (p=0.132) did not differ statistically between the groups. However, the occurrence of both pneumonia and wound infections the in the Hybrid group compared to the minimally invasive group (T-MIE and RAMIE) is statistically significant worse (p=0.046 and p=0.003 respectively).
Conclusion:
Although the T-MIE as well as the RAMIE group contained the first 25 patients treated in this clinic with this procedures, comparable results with regard to oncological outcomes and morbidity could be achieved. Additionally the minimal invasive approaches seem to be associated with low occurrence of pneumonia and wound infects.
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