Robotic-assisted minimally invasive esophagectomy versus the conventional minimally invasive one: A meta-analysis and systematic review

BackgroundConventional video-assisted minimally invasive esophagectomy (MIE) is safe and associated with low rates of morbidity and mortality, but the two-dimensional monitor reduces eye-hand harmony and viewing yield. Robotic-assisted minimally invasive esophagectomy (RAMIE) with its virtual reality simulators offers a realistic three-dimensional environment that facilitates dissection in the narrow working space, but it is expensive and requires longer operative time. Therefore, the aim of this meta-analysis was to assess the safety and feasibility of RAMIE versus MIE in patients with esophageal cancer. Material and MethodsPubMed, EMBASE, Cochrane library, and Chinese Biomedical Literature databases were systematically searched up to 21 September 2018 for case-controlled studies that compared RAMIE with MIE. ResultEight case-controlled studies involving 1862 patients (931 under RAMIE and 931 under MIE) were considered. No statistically significant difference between the two techniques was observed regarding R0 resection rate (OR=1.1174, P=0.8647), conversion to open (OR=0.7095, P=0.7519), 30-day mortality rate (OR=0.8341, P=0.7696), 90-day mortality rate (OR=0.3224, P=0.3329), in-hospital mortality rate (OR=0.3733, P=0.3895), postoperative complications, number of harvested lymph nodes (mean difference [MD]=0.8216, P=0.2039), operation time (MD=24.3655min, P=0.2402), and length of stay in hospitals (LOS) (MD=-5.0228day, P=0.1342). The meta-analysis showed that RAMIE was associated with a significantly fewer estimated blood loss (EBL) (MD=-33.2268mL, P=0.0075). And the vocal cord palsy rate was higher in the MIE group compared with RAMIE, and the difference was significant (OR=0.5696, P=0.0447). ConclusionThis meta-analysis indicated that RAMIE and MIE display similar feasibility and safety when used in esophagectomy. However, randomized controlled studies with larger sample sizes are needed to evaluate the benefit and harm in patients with esophageal cancer undergoing RAMIE.