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SURGICAL OUTCOMES OF ROBOTIC VS. LAPAROSCOPIC IVOR LEWIS ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED STUDY
Andres Ramos-Fresnedo
*, Keouna Pather, Chelsea Yap, Brian G. Celso, Erin M. Mobley, Ziad Awad
Department of Surgery, University of Florida Health Science Center Jacksonville, Jacksonville, FL
Objective: The objective of this study is to compare the surgical outcomes of Laparoscopic Minimally Invasive Ivor Lewis esophagectomy (MIE) to Robotic Assisted Minimally Invasive Esophagectomy (RAMIE).
Methods: We collected retrospective medical record data among all adults (?18 years) who underwent Ivor Lewis esophagectomy from September 2013 to November 2024 at a single institution. Propensity score matching (PSM) was used to match MIE to RAMIE cases at a ratio of 1:1 and a caliper of 0.02 with the following variables: age, sex, race, body mass index, type of cancer, receipt of neoadjuvant treatment, and presence of diabetes or cardiovascular disease based on prior published analyses with the same data indicated an influence of these variables on peri-operative outcomes. A multivariable logistic regression model adjusting for the above variables, followed by an omnibus test of model coefficients, were used to confirm goodness of fit prior to PSM (
p=0.047). Two-tailed student t-tests were used to compare means and two-tailed z-tests were used to compare the difference in proportions between both groups, as appropriate. A p-value <0.05 was considered significant.
Results: A total of 303 consecutive patients underwent Ivor Lewis esophagectomy during the study period, and of those, 71 (23.4%) were RAMIE. After matching, 62 cases were included in each group. Detailed results are depicted in
Table 1. The mean number of lymph nodes harvested was higher in the RAMIE (25.73) versus MIE (20.05,
p<0.001). The mean operative time was longer in RAMIE (488 minutes) versus MIE (397,
p<0.001). The mean length of stay was longer in RAMIE (13.95 days) versus MIE (10.15 days,
p=0.016). There were no significant differences in rates of positive margins on final pathology, conversion to open, complications, 30- or 90-day readmissions, 30- or 90-day mortality, and reoperation within 90 days (p>0.05).
Conclusions: In this study, RAMIE is associated with improved lymphadenectomy but increased in operative time and length of stay compared to MIE. RAMIE and MIE Minimally are otherwise associated with similar mortality, morbidity, and perioperative outcomes. Prospective studies across multiple institutions should investigate whether the findings regarding differences across RAMIE compared to MIE are similarly associated with improved lymph node resection may translate to improved oncologic outcomes.
Perioperative outcomes of laparoscopic vs. robotic esophagectomy
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