Remarkable Success in Robot-Assisted Esophagectomy Procedures

Recent findings from Roswell Park Comprehensive Cancer Center highlight an impressive achievement in surgical outcomes for robot-assisted, minimally invasive esophagectomies (RAMIE). A study published in the Journal of Gastrointestinal Surgery indicates that 90% of 150 consecutive RAMIE procedures performed between 2020 and 2024 resulted in what the surgical community refers to as 'textbook outcomes.'

'Textbook outcomes' are defined by specific metrics such as the duration of hospital stays, rates of complications, readmissions, and mortality within 30 days post-surgery. The results from Roswell Park significantly surpass those from other high-volume international medical centers, which typically report a range of 40% to 45% for similar outcomes.

According to Dr. Moshim Kukar, Chair of Surgical Oncology at Roswell Park and lead author of the study, these results represent some of the best data available for this particular surgical procedure. The majority of patients in this study were diagnosed with stage T3 tumors, where cancer has spread to nearby lymph nodes or tissues.

Esophagectomy, the surgical removal of the affected segment of the esophagus, is a common treatment for esophageal cancer. During the procedure, the stomach is repositioned into the chest cavity to create a new connection with the remaining esophagus.

Esophagectomies are known to carry serious risks, with a typical mortality rate ranging from 3% to 5%, even in high-volume surgical centers. However, the Roswell Park team achieved remarkably low mortality rates of 0.7% at 30 days and 1.3% at 90 days, which is significantly below the expected risk for such complex surgeries.

The study also reported a notably low incidence of anastomotic leaks, a severe complication where the surgical connection between the stomach and esophagus fails to heal properly. Such leaks can lead to serious health issues, necessitating additional surgeries and prolonged hospital stays, which can negatively impact overall survival rates and delay necessary adjuvant therapies.

In this study, only two patients experienced an anastomotic leak, neither of whom required further surgery. The surgical team at Roswell Park utilizes a 'side-to-side stapled anastomotic technique,' which has demonstrated a lower risk of leakage compared to alternative methods.

Since adopting RAMIE techniques in 2020, all esophagectomies at Roswell Park have been performed using this method, which involves smaller incisions in the abdomen and chest, facilitated by robotic assistance. This approach generally results in reduced blood loss and minimizes the risk of postoperative infections, including pneumonia.

The robotic system provides surgeons with a three-dimensional, magnified view of the surgical site and allows for greater precision in suturing. Patients undergoing robotic surgery often experience less postoperative pain and shorter hospital stays. In the Roswell Park study, the median hospital stay for patients was seven days.

With an annual count of 60 to 70 RAMIE procedures, Roswell Park is well above the threshold for classification as a high-volume center. Since 2014, Dr. Kukar and his team have performed over 700 minimally invasive esophagectomies, including 150 during the reported period, establishing the center as a leader in this surgical field.

For more detailed insights, refer to the study titled "Achieving textbook outcomes with robotic-assisted Ivor Lewis esophagectomy: a single-center experience with 150 consecutive patients" published in the Journal of Gastrointestinal Surgery.