Technical improvements of the anastomotic technique in robotic assisted minimally invasive esophagectomy (RAMIE) can significantly reduce anastomotic leak rates - Experience of a German High-Volume Center

Introduction and aim Minimally invasive surgery and lately the usage of robotic technology has reduced the invasiveness of procedures, leading to improved patient outcomes after esophagectomy. The esophagogastric anastomosis represents a crucial step of the Ivor-Lewis procedure, as technical errors may lead to anastomotic leakage and severe postoperative morbidity. The aim of this study was to present and evaluate our standardized robotic circular stapled anastomotic technique in comparison to our large Hybrid patient collective.

Methods Analysis of our prospectively collected, IRB approved database of hybrid, open, and robotic esophagectomies was performed. Starting 01/2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and indocyanine green for our RAMIE cases at our academic center. Outcomes of patients undergoing this standardized robotic Ivor Lewis esophagectomy for esophageal cancer from 01/2019 - 11/2020 were compared to our overall cohort from 06/2016-06/2020 (Hybrid/Open group).

Results A total of 615 patients were analyzed. A total of 96 patients underwent a robotic assisted Ivor Lewis esophagectomy. Of these, a total of 56 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis. A total of 64 patients were operated using an open approach and 455 underwent a hybrid procedure with a circular stapled anastomosis (Hybrid/Open group). Demographic and oncological data is shown in [Abb 1] as well as postoperative complications. One patient developed an anastomotic leak in the robotic group, resulting in an anastomotic leak rate of 1.8 %. In comparison 63 patients (12 %) developed an anastomotic leak in the Hybrid/Open group (p = 0.0132).

Conclusion A standardized circular stapled anastomosis in RAMIE cases for esophageal cancer may result in very low anastomotic leak rates and thereby positively influence outcomes in selected esophageal cancer patients.

Abb 1

Publication History

Article published online:
07 September 2021