Key result
Robotic esophagectomy had similar anastomotic leak rates to laparoscopic and open approaches (18% vs 14% vs 13%; P=0.123) but required less invasive management for leaks (54% vs 79% vs 75%; P=0.004).
Why the study?
Anastomotic leaks after esophagectomy carry significant morbidity, but data describing their association with open versus minimally invasive operative approaches are lacking.
Does a robotic approach alter the rate or management of anastomotic leaks compared to open or laparoscopic approaches in patients undergoing esophagectomy for cancer?
Cohort (n=2,696)
Yes
Does a robotic approach alter the rate or management of anastomotic leaks compared to open or laparoscopic approaches in patients undergoing esophagectomy for cancer?
Absolute Event Rate: 18% vs 13%
p-value: p=0.123
While the surgical approach does not significantly impact the incidence of anastomotic leaks after esophagectomy for cancer, leaks following a robotic approach may require less invasive management.
Robotic approach was associated with fewer intervention-requiring leaks; leaves open whether operative technique meaningfully alters leak incidence or outcomes.
Introduction Although mortality rates after esophagectomy have decreased over the last 30 years, anastomotic leaks still commonly persist and portend significant morbidity. Previous studies have analyzed patient and perio-perative risk factors for leaks, yet data describing the association of leaks and an open or minimally invasive approach are lacking. The purpose of this study was to evaluate the impact of operative approach on leak rates and subsequent management of the leaks. Methods We queried the Procedure-Targeted National Surgical Quality Improvement Program Database for patients undergoing esophagectomy for cancer in the years from 2016 to 2019. Patient demographics, disease-related information, peri-operative data, and short-term outcomes were reviewed. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with post-operative anastomotic leaks. Results Of the 2696 patients who underwent esophagectomy for cancer, anastomotic leaks occurred in 374 (14%). Based on approach, 13% of open, 14% of laparoscopic, and 18% of robotic cases were complicated by leak ( P = .123). Multivariable analysis identified the following significant risk factors for leak: diabetes (OR 1.32, P = .047), hypertension (OR 1.32, P = .022), and longer operative time (OR 1.61, P < .001). The percentage of leaks requiring endoscopic or operative intervention was 75% for open, 79% for laparoscopic, and 54% for robotic cases ( P = .004). Conclusions Anastomotic leaks after esophagectomy for cancer occur frequently regardless of surgical approach. Furthermore, these leaks are managed differently after an open, laparoscopic, or robotic approach. Robotic esophagectomies complicated by anastomotic leak required less invasive management.
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Wu et al. (2022) conducted a cohort in Esophageal cancer (n=2,696). Robotic esophagectomy vs. Open or laparoscopic esophagectomy was evaluated on Post-operative anastomotic leaks (p=0.123). Robotic esophagectomy had similar anastomotic leak rates to laparoscopic and open approaches (18% vs 14% vs 13%; P=0.123) but required less invasive management for leaks (54% vs 79% vs 75%; P=0.004).
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