Surgery · Oncology ·
Meta-analysis compares robotic and conventional esophagectomy after chemoradiotherapy
A systematic review and meta-analysis of seven observational studies included 2,395 patients undergoing esophagectomy after predominantly neoadjuvant chemoradiotherapy. Robotic-assisted surgery was associated with less blood loss, a shorter hospital stay and greater lymph-node yield, while measured oncologic and short-term safety outcomes did not differ significantly.
- Seven observational studies included 2,395 patients.
- RAMIE was associated with lower blood loss and shorter stay.
- Lymph-node yield was higher with RAMIE.
- No significant differences in reported oncologic or safety outcomes.
Robotic-assisted minimally invasive esophagectomy (RAMIE) is an alternative to conventional minimally invasive esophagectomy (CMIE), but its performance after neoadjuvant chemoradiotherapy (nCRT) is uncertain. This systematic review and meta-analysis pooled comparative studies of patients undergoing esophagectomy after predominantly nCRT-based treatment. Seven studies, all observational, contributed data on 2,395 patients: 609 underwent RAMIE and 1,786 CMIE. Random-effects models were used, and risk of bias was assessed with ROBINS-I.
Compared with CMIE, RAMIE was associated with 26.44 mL less estimated blood loss (95% CI −34.36 to −18.51), a hospital stay shorter by 1.78 days (95% CI −3.41 to −0.15), and 2.60 more lymph nodes retrieved (95% CI 1.81–3.38). The analysis found no significant differences in pathologic complete response, R0 resection, overall postoperative complications, anastomotic leak, or 30- and 90-day mortality.
The findings suggest perioperative differences but do not establish that RAMIE improves cancer outcomes or is equivalent in safety. Because the evidence comes from observational studies, confounding and other study limitations may affect the comparisons; the results alone do not establish that one approach should be preferred.
In practice
For patients undergoing esophagectomy after predominantly nCRT-based treatment, this meta-analysis found RAMIE associated with modestly lower blood loss, a shorter hospital stay and greater lymph-node yield than CMIE. It found no significant differences in pathologic complete response, R0 resection, postoperative complications, anastomotic leak or short-term mortality. These data may inform discussion of operative approaches, but they do not establish a preferred technique: the seven included studies were observational, so confounding and other biases limit conclusions about comparative effectiveness and safety.
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Surgical Endoscopy: Robotic-assisted versus conventional minimally invasive esophagectomy after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.