International Session（Symposium）8(JSGS・JGES)
Sat. November 7th   9:30 - 11:10   Room 8: Portopia Hotel Main Building Kairaku 1+2
IS-S8-3_S
 Use of the surgical robot may reduce morbidity after minimally invasive surgery for upper GI malignancies
Koichi Suda1, Susumu Shibasaki1, Ichiro Uyama1
1Department of Surgery, Fujita Health University
Background: Clinical advantages of robotic surgical procedures over conventional minimally invasive surgery (cMIS) have remained unclear.
Methods: Since 2009, we have been performing robotic gastrectomy (RG) and esophagectomy (RE) for operable patients with resectable gastric and esophageal cancer, respectively. The‘double bipolar method’, ‘da Vinci’s plane theory’, and ‘monitor quadrisection theory’ were established to overcome limited hemostability of its energy devices, and conflicts of the robotic arms and forceps. Lymph node dissection in RG has been conducted based on the outermost layer-oriented approach, of which the concept has been extensively used for RE since 2018. Retrospective chart reviews were conducted.
Results: Regarding RG, postoperative morbidity (Clavien-Dindo Grade≥IIIa) was significantly improved (RG vs. cMIS between 2009 and 2019, 13/359 (3.6%) vs. 92/1042 (8.8%), p=0.002). Three-year long-term outcomes did not differ between RG and cMIS (between 2009 and 2012), however, RG was an independent positive predictor of five-year recurrence-free survival in pStage II/III patients (between 2009 and 2014, hazard ratio: 0.564 [0.331–0.962], p = 0.035). Regarding RE, the incidence of postoperative recurrent laryngeal nerve palsy was dramatically reduced (between 2018 and 2019, Grade ≥I, 10.8%).
Conclusions: Robotic upper GI surgery, based on the outermost-layer oriented approach, may contribute to reduction in postoperative morbidity. Further evidence on its long-term outcomes is awaited.
Index Term 1: Robotic Surgical Procedures
Index Term 2: Upper Gastrointestinal Tract
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