Mckeown Esophagectomy: Minimally Invasive Robot-Assisted vs Conventional Technique - Systematic Review and Meta-Analysis of Randomized Clinical Trial

Abstract

Introduction

Currently, conventional minimally invasive esophagectomy (MIE) is the preferred surgical approach for esophageal cancer. Despite the increasing popularity of robot-assisted minimally invasive esophagectomy (RAMIE), its potential advantages over MIE are yet unknown.

Methods

We searched PubMed, Embase, and the Cochrane database for randomized controlled trials (RCTs) comparing RAMIE to MIE in patients with esophageal cancer that reported the outcomes of interest. Mean differences (MD) with 95% confidence intervals (CI) were collected. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration). Heterogeneity was assessed with I² statistics.

Results

We included three RCTs with 721 patients, of whom 364 (50,4%) underwent RAMIE. The number of dissected nodes increased in patients undergoing RAMIE (MD 3.72; 95% CI 1.07 to 6.37; P = 0.006). Similar results were observed in a subanalysis of the number of dissected thoracic nodes (MD 1.36 nodes; 95% Cl 0.12 to 2.61; P = 0.03), but not abdominal nodes (MD 0.30 nodes; 95% Cl −0.69 to 1.29; P = 0.55). RAMIE was associated with a reduction in blood loss (MD −47.76 mL; 95% Cl −70.06 to −25.46; P = <0.0001), thoracic operative time (MD −21.96 minutes; 95% Cl −33.82 to −10.10; P = 0.0003) and abdominal operative time (MD −15.10 minutes; 95% Cl −18.51 to −11.69; P = <0.00001) compared to MIE.

Conclusions

This meta-analysis of RCTs found that, in patients with esophageal cancer, RAMIE increased the number of dissected nodes and reduced blood loss and operative time compared with MIE.