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Incidence of Recurrent Laryngeal Nerve Palsy in Robot-Assisted Versus Conventional Minimally Invasive McKeown Esophagectomy in Prone Position: A Propensity Score-Matched Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Esophagectomy with lymphadenectomy is the principal treatment for localized esophageal cancer. Conventional minimally invasive esophagectomy (C-MIE) in prone position has spread worldwide as it is less invasive. However, its efficacy remains controversial. Robot-assisted MIE (RAMIE) can have more advantages than C-MIE. Therefore, the current study aimed to validate whether RAMIE is associated with lower incidence of left recurrent laryngeal nerve (RLN) palsy compared with C-MIE in prone position.

Patients and Methods

In total, 404 patients with esophageal carcinoma underwent MIE (353 C-MIEs and 51 RAMIEs) in prone position at Kobe University between 2010 and 2020. Then, propensity score matching was performed, and results showed that 51 patients should be included in each group. Thereafter, the perioperative outcomes between the two groups were compared.

Results

The RAMIE group had a significantly longer operative time than the C-MIE group (P < 0.0001). However, the number of lymph nodes resected along the left RLN was similar in both groups. Moreover, the incidence of left RLN palsy was significantly lower in the RAMIE group than in the C-MIE [Clavien–Dindo classification grade II; 0 (0%) versus 32 (9%), P = 0.022 in entire cohort, and 0 (0%) versus 5 (10%), P = 0.022 in matched cohort. Esophagectomy Complications Consensus Group definitions type I; 8 (16%) versus 101 (29%), P = 0.041 in entire cohort and 8 (16%) versus 18 (35%) in matched cohort, P = 0.023].

Conclusion

RAMIE is superior to C-MIE in prone position in decreasing the incidence of left RLN palsy.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Taro Oshikiri MD, PhD, Hironobu Goto MD, Manabu Horikawa MD, Naoki Urakawa MD, PhD, Hiroshi Hasegawa MD, PhD, Shingo Kanaji MD, PhD, Kimihiro Yamashita MD, PhD, Tetsu Nakamura MD, PhD & Yoshihiro Kakeji MD, PhD

  2. Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Takeru Matsuda MD, PhD

Authors
  1. Taro Oshikiri MD, PhD
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  2. Hironobu Goto MD
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  3. Manabu Horikawa MD
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  4. Naoki Urakawa MD, PhD
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  5. Hiroshi Hasegawa MD, PhD
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  8. Takeru Matsuda MD, PhD
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  9. Tetsu Nakamura MD, PhD
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  10. Yoshihiro Kakeji MD, PhD
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Correspondence to Taro Oshikiri MD, PhD.

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Oshikiri, T., Goto, H., Horikawa, M. et al. Incidence of Recurrent Laryngeal Nerve Palsy in Robot-Assisted Versus Conventional Minimally Invasive McKeown Esophagectomy in Prone Position: A Propensity Score-Matched Study. Ann Surg Oncol 28, 7249–7257 (2021). https://doi.org/10.1245/s10434-021-10123-w

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