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Background <p>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.</p> Methods <p>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.</p> <p>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.</p> Results <p>Patients with a narrow mediastinum and left-shifted esophagus had a&#xa0;higher&#xa0;incidence&#xa0;of&#xa0;recurrent laryngeal nerve (RLN)&#xa0;palsy and fewer lymph nodes dissections than other patients (<i>p</i> = 0.026 and <i>p</i> = 0.051, respectively). In the entire cohort, the operative time in the RAMIE group was longer than that in the C-MIE group (&lt; 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 (<i>p</i> &lt; 0.0001, 0.0001, and 0.0001, respectively). Regarding the RLN palsy, there was no significant difference (<i>p</i> = 0.79).</p> Conclusions <p>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.</p>

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Performing robot-assisted minimally invasive esophagectomy for patients with a narrow mediastinum and left-shifted esophagus for esophageal squamous cell carcinoma presents further challenges

  • 期刊论文

  • 发表日期：

    2025年5月14日

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  • 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

摘要

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.