Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) may be a lower-cost alternative, with better post-operative outcomes, to open transthoracic esophagectomy (OTE) for patients with esophageal cancer, according to research being presented at the 2018 Gastrointestinal Cancers Symposium in San Francisco, California.

Chemotherapy or chemoradiotherapy plus OTE is the standard curative treatment for esophageal cancer, though some evidence suggests that RAMIE may improve postoperative outcomes. For the randomized phase 3 ROBOT trial (ClinicalTrials.gov Identifier: NCT01544790), researchers enrolled 112 patients to undergo RAMIE or OTE.

Postoperative complications were less frequent in the RAMIE group (59%) than in the OTE group (80%; relative risk, 0.74; P =.02). RAMIE was also associated with less blood loss and a lower rate of surgery-related, pulmonary, and cardiac complications.

Patients in the RAMIE group had better functional recovery at day 14 and a better quality of life score at discharge and at 6 weeks after discharge. The authors also reported a lower mean cost for RAMIE.

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At a median follow-up of 38 months, overall and disease-free survival rates were similar between the groups.

The authors concluded that “RAMIE resulted in a lower percentage of overall, surgery-related and (cardio)pulmonary complications with lower postoperative pain, better quality of life and a better short term postoperative functional recovery compared to OTE. Oncological outcomes were equal.”

Reference

Van Der Sluis PC, van der Horst S, May AM, et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Oral presentation at: 2018 Gastrointestinal Cancers Symposium; January 18-20, 2018; San Francisco, CA.