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Esophageal cancer

Robotic-assisted transhiatal esophagectomy is safe and effective for certain patients

por Lauren Dubinsky , Senior Reporter
A new study from Allina Health confirmed that robotic-assisted transhiatal esophagectomy is safe and effective for a specific patient population.

The research was published in the current issue of the journal of the International Society for Diseases of the Esophagus, Diseases of the Esophagus.

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"Patients who have an RATE operation have relatively less pain, less time in the ICU, less time in the hospital and a return to a more normal life style compared to many of the more traditional operations for esophageal cancer," Dr. Daniel Dunn, the study's principle investigator, told HCB News.

RATE has the potential to improve postoperative outcomes, but it’s a technically complex procedure. Due to the technical difficulties and unique skills that the surgeons and operating room staff must learn, very few centers have adopted robots for this procedure, according to Dunn.

"The robotic operation for esophageal cancer requires additional training not offered in all surgical programs," he added. "The proficient use of the robotic technology is required before one tries a complicated, technically demanding operation such as RATE. There is also a manpower issue because this operation should be performed with two similarly trained surgeons."

Dunn and his colleagues collected clinical, outcome and survival data on 98 patients with esophageal cancer and two with benign conditions who underwent RATE between March 2007 and December 2014. They then estimated the rate of progression-free and overall survival using the Kaplan-Meier curves.

They found that the median operative time was 264 minutes and estimated blood loss was 75 milliliters. The median length of ICU stay was one day and the median hospital stay was eight days.

In terms of postoperative complications, 38 percent experienced non-malignant pleural effusion, 33 percent recurrent laryngeal nerve injury and the 30-day mortality rate was 2 percent.

After a follow-up period of about 28 months, the median PFS was 41 months and overall survival was 54 months. One-year and three-year PFS rates were 82 percent and 53 percent, respectively, and overall survival rates were 95 percent and 57 percent.

The research team concluded that RATE is “an effective and safe oncologic surgical procedure in a carefully selected group of patients.” They also noted that it has acceptable operative time, minimal blood loss, standard postoperative morbidity and adequate PFS and overall survival profiles.

RATE is ideal for patients without large bulky tumors, tumors located in the middle of the esophagus, trachea, bronchus or vascular structures in the mediastinum, a history of thoracic surgical procedures and abnormal body habitus. In addition, those who are otherwise healthy without other illnesses such as heart disease, diabetes, hypertension, obesity, lung disease and a smoking history would have a relatively safe operation.

The effectiveness of the operation was proven in two ways. The first was its ability to remove the tumor completely without any evidence of disease left behind after the operation — 97 percent of the patients had complete resection of their tumors.

"The second way to look at effectiveness is how the patients do in the recovery and the long-term debility caused by the operation," said Dunn. "The recovery from any operative approach for esophageal cancer is difficult for the patient and associated with complications in a high percentage of cases."

However, patients who underwent the RATE procedure experienced fewer complications and left the hospital sooner than patients who underwent traditional surgery.

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