Performing robot-assisted minimally invasive esophagectomy for patients with a narrow mediastinum and left-shifted esophagus for esophageal squamous cell carcinoma presents further challenges
- 14.05.2025
Erschienen in:
- Verfasst von
- Yasufumi Koterazawa
- Hironobu Goto
- Tomoaki Aoki
- Ryuichiro Sawada
- Taro Ikeda
- Hitoshi Harada
- Yasunori Otowa
- Naoki Urakawa
- Hiroshi Hasegawa
- Shingo Kanaji
- Kimihiro Yamashita
- Takeru Matsuda
- Taro Oshikiri
- Yoshihiro Kakeji
- Erschienen in
- Surgical Endoscopy | Ausgabe 7/2025
Abstract
Background
Several studies have compared robot-assisted minimally invasive esophagectomy (RAMIE) with conventional minimally invasive surgery (C-MIE). However, the anatomical factors that may make certain patients more suitable for RAMIE remains unclear. This study compared the surgical outcomes of RAMIE with those of C-MIE in patients with narrow mediastinum and left-shifted esophagus.
Methods
Between January 2017 and December 2023, 260 patients with esophageal squamous cell carcinoma (ESCC) who underwent MIE (C-MIE or RAMIE) at Kobe University Hospital were included in the study.
We developed a new index to assess the narrow mediastinum and left-shifted esophagus at the tracheal bifurcation level using computed tomography imaging. Cox proportional hazards regression analyses were performed to identify the prognostic factors.
Results
Patients with a narrow mediastinum and left-shifted esophagus had a higher incidence of recurrent laryngeal nerve (RLN) palsy and fewer lymph nodes dissections than other patients (p = 0.026 and p = 0.051, respectively). In the entire cohort, the operative time in the RAMIE group was longer than that in the C-MIE group (< 0.0001). No significant differences in other variables, including RLN palsy, were observed between the two groups. Among patients with narrow mediastinum and left-shifted esophagus, RAMIE was associated with longer operative time and fewer lymph nodes dissected from the left and right sides of the upper mediastinum compared to C-MIE (p < 0.0001, 0.0001, and 0.0001, respectively). Regarding the RLN palsy, there was no significant difference (p = 0.79).
Conclusions
There are challenges in performing RAMIE in patients with a narrow mediastinal and left-shifted esophagus. Therefore, establishing an effective procedure for these patients is important.
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- Titel
- Performing robot-assisted minimally invasive esophagectomy for patients with a narrow mediastinum and left-shifted esophagus for esophageal squamous cell carcinoma presents further challenges
- Verfasst von
-
Yasufumi Koterazawa
Hironobu Goto
Tomoaki Aoki
Ryuichiro Sawada
Taro Ikeda
Hitoshi Harada
Yasunori Otowa
Naoki Urakawa
Hiroshi Hasegawa
Shingo Kanaji
Kimihiro Yamashita
Takeru Matsuda
Taro Oshikiri
Yoshihiro Kakeji
- Publikationsdatum
- 14.05.2025
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 7/2025
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-025-11713-5
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