A Systematic Review of Robotic-Assisted Surgery in Esophageal Cancer: Comparison with Open Esophagectomy

OBJECTIVES: This study assess the safety and effectiveness of robotic-assisted esophagectomy (RAE) compared with open esophagectomy (OE) for esophageal cancer patients.

METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE via Ovid, on 12 April 2022 for randomized clinical trials (RCTs) according to key question. Two authors independently selected studies for inclusion, assessed the risk of bias, and extracted study data. We included complications, conversion to OE in safety related outcome, and operation time, bleeding loss, pain, recurrence, resection lymph nodes, length of stay, 5-year overall survival rate, 5-year disease-free survival, and quality of life in effectiveness related outcome.

RESULTS: A total of 2 articles (One RCT study) were included. In complications for patients with modified Clavien-Dindo classification 2 or higher, RAE reported lower complications than OE. Among the postoperative complications, RAE was reported to be lower than OE in lung complications (p=0.005) and cardiovascular disease (p=0.006). Conversion from RAE to OE was reported to have occurred in 3 of 54 (5.56%) patients. RAE was a significantly longer operation time (p<0.001), but RAE was significantly lower bleeding loss (p<0.001), pain (p<0.001), and better quality of life (p<0.05) than OE. There was no statistically significant difference in recurrence, resection lymph nodes, length of stay, 5-year overall survival rate, and 5-year disease-free survival.

CONCLUSIONS: We suggest that RAE is a feasible and safe alternative to OE for esophageal cancer on the basis of current data. Additionally, more studies are required to provide evidence regarding the benefits and cost-effectiveness of RAE.