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Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer.

 S. Y. Park  ;  D. J. Kim  ;  W. S. Yu  ;  H. S. Jung 
 Diseases of the Esophagus, Vol.29(4) : 326-332, 2016 
Journal Title
 Diseases of the Esophagus 
Issue Date
Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Esophageal Neoplasms*/mortality ; Esophageal Neoplasms*/pathology ; Esophageal Neoplasms*/surgery ; Esophagectomy*/adverse effects ; Esophagectomy*/methods ; Female ; Humans ; Lymph Node Excision*/adverse effects ; Lymph Node Excision*/methods ; Lymph Nodes*/pathology ; Lymph Nodes*/surgery ; Lymphatic Metastasis ; Male ; Mediastinum ; Middle Aged ; Operative Time ; Outcome and Process Assessment (Health Care) ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Robotic Surgical Procedures*/adverse effects ; Robotic Surgical Procedures*/methods ; Thoracoscopy*/adverse effects ; Thoracoscopy*/methods
esophageal cancer ; outcome ; robotic surgery
The study aims to report the operative outcomes of robot-assisted thoracoscopic esophagectomy (RATE) with extensive mediastinal lymphadenectomy (ML) for intrathoracic esophageal cancer. We analyzed a prospective database of 114 consecutive patients who underwent RATE with lymph node dissection along recurrent laryngeal nerve (RLN) followed by cervical esophagogastrostomy. The study included 104 men with a mean age of 63.1 ± 0.8 years. Of these, 110 (96.5%) had squamous cell carcinoma, and the location of the tumor was upper esophagus in 7 (6.1%), middle in 62 (54.4%), and lower in 45 (39.5%). Preoperative concurrent chemoradiation was performed in 15 patients (13.2%). All but one patient underwent successful RATE, and R0 resection was achieved in 111 patients (97.4%). Extended ML and total ML were performed in 24 (21.1%) and 90 (78.9%) patients, respectively. Total operation time was 419.6 ± 7.9 minutes, and robot console time was 206.6 ± 5.2 minutes. The mean number of total, mediastinal, and RLN nodes was 43.5 ± 1.4, 24.5 ± 1.0, and 9.7 ± 0.7, respectively. The most common complication was RLN palsy (30, 26.3%), followed by anastomotic leakage (17, 14.9%) and pulmonary complications (11, 9.6%). Median hospital stay was 16 days, and 90-day mortality was observed in three patients (2.5%). On multivariate analysis, preoperative concurrent chemoradiation was a risk factor for pulmonary complications (odds ratio 7.42, 95% confidence interval 1.91-28.8, P = 0.004). RATE with extensive ML could be performed safely with acceptable postoperative outcomes. Long-term survival data should be followed in the future to verify the oncological outcome of the procedure.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
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