The Annals of thoracic surgery | 2019
Early Quality of Life Outcomes After Robotic-Assisted Minimally Invasive and Open Esophagectomy.
Abstract
BACKGROUND\nMinimally invasive esophagectomy (MIE) may improve some perioperative outcomes over open approaches; effects on quality of life (QOL) are less clear.\n\n\nMETHODS\nA prospective trial of robotic-assisted MIE (RAMIE) and open esophagectomy (OE) was initiated, measuring QOL via the Functional Assessment of Cancer Therapy-Esophageal (FACT-E) and Brief Pain Inventory (BPI). Mixed generalized linear models assessed associations between QOL scores over time and by surgery type.\n\n\nRESULTS\nIn total, 106 patients underwent OE; 64 underwent MIE (98% RAMIE). The groups did not differ in age, sex, comorbidities, histologic subtype, stage, or induction treatment (P=0.42 to >0.95). Total FACT-E scores were lower at 1 month (P<0.001), returned to near baseline by 4 months, and did not differ between groups (P=0.83). BPI average pain severity (P=0.007) and interference (P=0.004) were lower for RAMIE. RAMIE had lower estimated blood loss (250 vs. 350 cc; P<0.001), shorter length of stay (9 vs 11 days; P<0.001), fewer ICU admissions (8% vs 20%; P=0.033), more lymph nodes harvested (25 vs 22; P=0.05), and longer surgical time (6.4 vs 5.4 h; P<0.001). Major complications (39% for RAMIE vs 52% for OE; P>0.95), anastomotic leak (3% vs 9%; P=0.41), and 90-day mortality (2% vs 4%; P=0.85) did not differ between groups. Pulmonary (14% vs 34%; P=0.014) and infectious (17% vs 36%; P=0.029) complications were lower for RAMIE.\n\n\nCONCLUSIONS\nRAMIE is associated with lower immediate postoperative pain severity and interference and decreased pulmonary and infectious complications. Ongoing data accrual will assess mid- and long-term outcomes in this cohort.