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Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer.
Jack P Silva1, Luke R Putnam1, Jessica Wu1
1Department of Surgery, Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA, USA.
The American Surgeon
|May 25, 2022
Summary
Minimally invasive esophagectomy (MIE) can convert to open surgery, but a robotic approach may reduce this risk. Converted patients face worse outcomes, highlighting the benefit of robotic-assisted surgery for esophagectomy.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Minimally invasive esophagectomy (MIE) is increasingly popular but often requires unplanned conversion to open surgery.
- Investigating risk factors for conversion and outcomes post-conversion is crucial for improving patient care.
Purpose of the Study:
- To identify risk factors associated with unplanned conversion from MIE to open esophagectomy.
- To compare outcomes between robotic-assisted MIE (RAMIE) and traditional MIE.
- To evaluate the impact of conversion on patient outcomes.
Main Methods:
- Analysis of the 2016-2019 Procedure Targeted NSQIP Database for patients undergoing MIE for cancer.
- Multivariable logistic regression to identify factors predicting conversion.
- Propensity-matched comparison of RAMIE versus traditional MIE.
Main Results:
- 10% of 1347 patients converted to open surgery.
- Morbid obesity, diabetes, hypertension, ASA class, and squamous cell carcinoma were linked to higher conversion rates.
- Robotic approach (RAMIE) showed a trend towards lower conversion (OR 0.57), but squamous cell carcinoma was the only independent predictor of conversion (OR 2.66).
- No significant difference in conversion rates, morbidity, or mortality between RAMIE and MIE in propensity-matched analysis.
Conclusions:
- Robotic-assisted esophagectomy may reduce unplanned conversions to open surgery.
- Conversion to open surgery is associated with poorer patient outcomes.
- Further research is needed to understand the mechanisms behind reduced conversions with robotic approaches.
