Robot assisted esophagectomy for esophageal squamous cell carcinoma

Background: This study aims to report our experience with robot assisted esophagectomy (RAE) for the treatment of resectable esophageal squamous cell carcinoma (ESCC). Methods: A series of 249 consecutive patients diagnosed with ESCC who underwent RAE from November 2015 to December 2017 at Shanghai Chest Hospital were evaluated, and their clinical data were reviewed retrospectively. One hundred patients were equally divided into four groups according to the surgery order, and the short-term outcomes in each group were analyzed. Results: Overall, 249 patients (201 males and 48 females) with a mean age of 63.4 +/- 7.3 years who underwent RAE were analyzed. The thoracic procedure was successfully performed with the assistance of a robot. The mean total duration was 250.6 +/- 58.4 mins, and the estimated blood loss was 215.5 +/- 87.6 mL. RO resection was performed in 232 (93.2%) patients with a mean total number of dissected lymph nodes of 18.5 +/- 9.1 and mean yield of lymph nodes along the recurrent laryngeal nerve (RLN) of 4.4 +/- 3.2. The median postoperative hospital stay was 11 days, and no 90-day mortality was observed. Forty-live (18.1%) patients experienced pulmonary complications, and the recurrent laryngeal nerve injury were observed in 38 (15.3%) patients. A significant reduction in thoracic duration was observed after the initial 25 cases (P<0.001). After 50 cases, the dissection of total lymph nodes, mediastinum lymph nodes and lymph nodes along the RLN were significantly improved (P<0.001, P<0.001, P=0.001, respectively) with a shorter postoperative hospital stay (P=0.005). Conclusions: RAE is a safe and feasible alternative surgical approach for resectable esophageal carcinoma and is associated with a large yield of lymph nodes, especially along the RLN. The surgeon will reach a plateau of operative duration after 25 cases and a plateau of lymphadenectomy after 50 cases.