Comparative Evaluation of Short-term Outcomes Between Initial and Later Periods After Introduction of Robot-assisted Surgery for Esophageal Cancer.
Robot-assisted minimally invasive esophagectomy (RAMIE) has swiftly gained global acceptance for the management of esophageal cancer; however, the associated learning curve may negatively impact patient outcomes. This study aimed to evaluate differences in surgical outcomes between the initial and subsequent periods and to assess the impact of accumulated experience in RAMIE in clinical practice.
We retrospectively reviewed 130 consecutive patients who underwent RAMIE at our institution. The initial period comprised the first 20 procedures performed by each of three surgeons (n=60), and the remaining procedures constituted the later period (n=70). Operative and postoperative outcomes were compared between the two periods, and factors associated with major postoperative complications were evaluated using logistic regression analysis.
Operative performance demonstrated significant improvement in the later period. Total, thoracic, and robotic operative times were significantly shorter (all p<0.001), and the number of thoracic dissected lymph nodes (LNs) was significantly higher (p=0.02). Thoracic blood loss exhibited a decreasing trend (p=0.07). Clinical outcomes also improved, with a significantly lower overall complication rate (p=0.04), reduced severity of postoperative complications (p=0.02), and a lower incidence of major complications (p=0.005) during the later period. No mortality was recorded, and the length of postoperative hospital stay did not differ significantly between the two periods. Multivariate analysis identified the later period as an independent factor associated with a reduced risk of major complications (odds ratio=0.30; 95% confidence interval=0.12-0.75; p=0.01).
Accumulated experience with RAMIE is correlated with improved operative time, enhanced LN dissection, and a reduction in postoperative complications, thereby supporting its continued safe and effective implementation following the initial learning curve.
We retrospectively reviewed 130 consecutive patients who underwent RAMIE at our institution. The initial period comprised the first 20 procedures performed by each of three surgeons (n=60), and the remaining procedures constituted the later period (n=70). Operative and postoperative outcomes were compared between the two periods, and factors associated with major postoperative complications were evaluated using logistic regression analysis.
Operative performance demonstrated significant improvement in the later period. Total, thoracic, and robotic operative times were significantly shorter (all p<0.001), and the number of thoracic dissected lymph nodes (LNs) was significantly higher (p=0.02). Thoracic blood loss exhibited a decreasing trend (p=0.07). Clinical outcomes also improved, with a significantly lower overall complication rate (p=0.04), reduced severity of postoperative complications (p=0.02), and a lower incidence of major complications (p=0.005) during the later period. No mortality was recorded, and the length of postoperative hospital stay did not differ significantly between the two periods. Multivariate analysis identified the later period as an independent factor associated with a reduced risk of major complications (odds ratio=0.30; 95% confidence interval=0.12-0.75; p=0.01).
Accumulated experience with RAMIE is correlated with improved operative time, enhanced LN dissection, and a reduction in postoperative complications, thereby supporting its continued safe and effective implementation following the initial learning curve.
Authors
Hamai Hamai, Ibuki Ibuki, Ohsawa Ohsawa, Kitasaki Kitasaki, Kishi Kishi, Kurokawa Kurokawa, Okada Okada
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