Incidence of Recurrent Laryngeal Nerve Palsy in Robot-Assisted Versus Conventional Minimally Invasive McKeown Esophagectomy in Prone Position: A Propensity Score-Matched Study

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Figure legends

Fig. 1 Flow of patient recruitment.

Of 472 patients who underwent MIE with either C-MIE or RAMIE between 2010 and

2020, 68 were excluded. Then, 51 patients were included in each group after propensity

score matching.

Table 1. Demographic and clinical characteristics of patients who underwent conventional or robot-assisted minimally invasive esophagectomy.

Whole cohort

Conventional MIE

group

(n = 353)

Age a)

67 (27–82)

Matched cohort

P value

Conventional MIE

RAMIE group

group

(n = 51)

67 (45–80)

Sex

(n = 51)

0.817 b)

67 (27–80)

P value

RAMIE group

(n = 51)

67 (45–80)

0.0010 c)

Male/female

301 (85%)/52 (15%)

34 (67%)/17 (33%)

Tumor location

0.537 c)

31 (61%)/20 (39%)

34 (67%)/17 (33%)

0.664 c)

0.529 c)

Ut

62 (18%)

12 (24%)

9 (18%)

12 (24%)

Mt

161 (45%)

20 (39%)

24 (47%)

20 (39%)

Lt

130 (37%)

19 (37%)

18 (35%)

19 (37%)

Histology

0.207 c)

0.357 c)

SCC/adeno ca.

325 (92%)/28 (8%)

45 (88%)/6 (12%)

Depth of tumor invasion

41 (80%)/10 (20%)

45 (88%)/6 (12%)

0.541 d)

0.712 c)

cT1

131 (37%)

21 (41%)

23 (45%)

21 (41%)

cT2

57 (16%)

7 (14%)

10 (20%)

7 (14%)

cT3

158 (45%)

23 (45%)

18 (35%)

23 (45%)

cT4

7 (2%)

0 (0%)

0 (0%)

0 (0%)

Lymph node metastasis

cN+/cN-

0.407

188 (53%)/165 (47%)

UICC-cStage

0.553 c)

c)

24 (47%)/27 (53%)

27 (53%)/24 (47%)

0.849 c)

0.763 b)

24 (47%)/27 (53%)

0.732 d)

122 (35%)

21 (41%)

21 (41%)

21 (41%)

II

86 (24%)

11 (22%)

7 (14%)

11 (22%)

III

117 (33%)

16 (31%)

19 (37%)

16 (31%)

IV

28 (8%)

3 (6%)

4 (8%)

3 (6%)

NAC

Yes/no

246 (70%)/107 (30%)

30 (59%)/21 (41%)

Abdominal procedure

Laparoscopy/open

29 (57%)/22 (43%)

30 (59%)/21 (41%)

0.678 d)

0.0002 d)

263 (74%)/90 (26%)

49 (96%)/2 (4%)

conduit

Stomach/others

0.841 c)

0.119 c)

47 (92%)/4 (8%)

49 (96%)/2 (4%)

1.000 d)

0.336 d)

331 (94%)/22 (6%)

50 (98%)/1 (2%)

Lymph node dissection

51 (100%)/0 (0%)

50 (98%)/1 (2%)

< 0.0001

1.000 d)

d)

3-/2-field

119 (34%)/234 (66%)

4 (8%)/47(92%)

3 (6%)/48 (94%)

4 (8%)/47(92%)

SCC, squamous cell carcinoma; adeno ca, adenocarcinoma; NAC, neoadjuvant chemotherapy; MIE, minimally invasive esophagectomy

a) Data were expressed as median (range).

b) Mann–Whitney U test.

c) χ2 test.

d) Fisher’s exact test.

Table 2. Operative outcomes of patients who underwent conventional or robot-assisted minimally invasive esophagectomy.

Whole cohort

Conventional MIE

group

(n = 353)

Matched cohort

P value

RAMIE group

Conventional MIE

RAMIE group

(n = 51)

group (n = 51)

(n = 51)

P value

Operative time a)

Overall procedure

679 (302–1215)

808 (360–1327)

< 0.0001 b)

655 (452–957)

808 (360–1327)

< 0.0001 b)

Thoracic procedure

300 (113–600)

440 (180–600)

< 0.0001 b)

300 (180–464)

440 (180–600)

< 0.0001 b)

Console time

358 (244–518)

Number of resected mediastinal

22 (10–74)

22 (11–34)

0.397 b)

23 (12–37)

22 (11–34)

0.556 b)

4 (0–18)

4 (0–10)

0.371 b)

4 (0–12)

4 (0–10)

0.324 b)

200 (0–10000)

35 (0–380)

< 0.0001 b)

100 (0–1485)

35 (0–380)

0.0012 b)

30 (9–583)

24 (15–96)

0.013 b)

27 (14–149)

24 (15–96)

0.615 b)

lymph nodes a)

Number of resected lymph nodes

along the left RLN a)

Volume of blood loss (mL)

358 (244–518)

Duration of postoperative hospital

stay a)

MIE, minimally invasive esophagectomy; RAMIE, robot-assisted minimally invasive esophagectomy

a) Data were expressed as median (range).

b) Mann–Whitney U test.

Table 3. RLN palsy in patients who underwent conventional or robot-assisted minimally invasive esophagectomy.

Whole cohort

Conventional MIE

group

(n = 353)

P value

Matched cohort

RAMIE group

Conventional MIE

RAMIE group

(n = 51)

group (n = 51)

(n = 51)

P value

RLN palsy

Right side

C–D classification a)

Grade I

10 (3%)

0 (0%)

0.622 d)

3 (6%)

0 (0%)

0.243 d)

Grade II

2 (1%)

0 (0%)

1.000 d)

0 (0%)

0 (0%)

Grade III

12 (3%)

0 (0%)

0.377 d)

0 (0%)

0 (0%)

Grades IV, V

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Type I

12 (3%)

0 (0%)

0.377 d)

3 (6%)

0 (0%)

0.243 d)

Type II

10 (3%)

0 (0%)

0.622 d)

0 (0%)

0 (0%)

Type III

2 (1%)

0 (0%)

1.000

0 (0%)

0 (0%)

Grade I

66 (19%)

8 (16%)

0.603 c)

13 (25%)

8 (16%)

0.221 c)

Grade II

32 (9%)

0 (0%)

0.022 d)

5 (10%)

0 (0%)

0.022 d)

Grade III

19 (5%)

0 (0%)

0.149 d)

3 (6%)

0 (0%)

0.243 d)

> Grades IV, V

0 (0%)

0 (0%)

0 (0%)

0 (0%)

ECCG definitions b)

d)

Left side

C–D classification a)

ECCG definitions b)

Type I

101 (29%)

8 (16%)

0.041 c)

18 (35%)

8 (16%)

0.023 c)

Type II

4 (1%)

0 (0%)

1.000 d)

1 (2%)

0 (0%)

1.000 d)

Type III

12 (3%)

0 (0%)

0.377 d)

2 (4%)

0 (0%)

0.495 d)

RLN, recurrent laryngeal nerve; MIE, minimally invasive esophagectomy; RAMIE, robot-assisted minimally invasive esophagectomy

a) Grades were based on the Clavien–Dindo classification of surgical complications.

b) Types were based on the Esophagectomy Complications Consensus Group definitions.

c) χ2 test.

d) Fisher’s exact test.

Table 4. Pneumonia in patients who underwent conventional or robot-assisted minimally invasive esophagectomy.

Whole cohort

Conventional MIE

group

(n = 353)

Matched cohort

P value

RAMIE group

Conventional MIE

RAMIE group

(n = 51)

group (n = 51)

(n = 51)

P value

Pneumonia

C–D classification a)

Grade I

3 (1%)

2 (4%)

0.122 d)

1 (2%)

2 (4%)

1.000 d)

Grade II

44 (12%)

7 (14%)

0.064 c)

6 (12%)

7 (14%)

0.767 c)

Grade IIIa

7 (2%)

0 (0%)

0.603 d)

2 (4%)

0 (0%)

0.495 d)

Grade IIIb

15 (4%)

0 (0%)

0.234 d)

2 (4%)

0 (0%)

0.495 d)

Grade IV

4 (1%)

0 (0%)

1.000 d)

0 (0%)

0 (0%)

Grade V

1 (0.3%)

0 (0%)

1.000 d)

0 (0%)

0 (0%)

279 (79%)

42 (82%)

0.300 c)

40 (78%)

42 (82%)

0.618 c)

3 (1%)

1 (2%)

0.418 d)

1 (2%)

1 (2%)

1.000 d)

22 (6%)

4 (8%)

0.539 d)

3 (6%)

4 (8%)

1.000 d)

23 (7%)

4 (7%)

0.763 d)

3 (6%)

4 (8%)

1.000 d)

>4

27 (8%)

0 (0%)

0.035 d)

4 (8%)

0 (0%)

0.118 d)

Uniform Pneumonia Score

b)

MIE, minimally invasive esophagectomy; RAMIE, robot-assisted minimally invasive esophagectomy

a) Grades were based on the Clavien–Dindo classification of surgical complications.

b) Scores were based on the Uniform Pneumonia Score. The definition is used for hospital-acquired pneumonia after esophagectomy.

* A score of > 2 with at least 1 point on pulmonary radiography indicates that suspected pneumonia must be treated.

c) χ2 test.

d) Fisher’s exact test.

Table 5. Anastomotic leakage in patients who underwent conventional or robot-assisted minimally invasive esophagectomy.

Whole cohort

Conventional MIE

group

(n = 353)

Matched cohort

P value

RAMIE group

Conventional MIE

RAMIE group

(n = 51)

group (n = 51)

(n = 51)

P value

Anastomotic leakage

C–D classification a)

Grade I

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Grade II

15 (4%)

1 (2%)

0.705 d)

3 (6%)

1 (2%)

0.618 d)

Grade III

51 (15%)

13 (25%)

0.056 c)

9 (18%)

13 (25%)

0.336 c)

Grade IV

0 (0%)

0 (0%)

0 (0%

Grade V

0 (0%)

0 (0%)

0 (0%

ECCG definitions b)

Type I

15 (4%)

1 (2%)

0.705 d)

3 (6%)

1 (2%)

0.618 d)

Type II

45 (13%)

13 (25%)

0.024 c)

8 (16%)

13 (25%)

0.221 c)

Type III

9 (3%)

0 (0%)

0.610 d)

1 (2%)

0 (0%)

1.000 d)

MIE, minimally invasive esophagectomy; RAMIE, robot-assisted minimally invasive esophagectomy

a) Grades were based on the Clavien–Dindo classification of surgical complications.

b) Types were based on the Esophagectomy Complications Consensus Group definitions.

c) χ2 test.

d) Fisher’s exact test.

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