title: Initial experience from a large referral center with robotic-assisted Ivor Lewis esophagogastrectomy for oncologic purposes.
abstract: BACKGROUND
  We report our initial experience of patients undergoing robotic-assisted Ivor Lewis esophagogastrectomy (RAIL) for oncologic purposes at a large-referral center.
  
  
  METHODS
  A retrospective review of all consecutive patients undergoing RAIL from 2010-2011 was performed. Basic demographics were recorded. Oncologic variables recorded included: tumor type, location, postoperative tumor margins, and nodal harvest. Immediate 30-day postoperative complications also were analyzed.
  
  
  RESULTS
  Fifty patients underwent RAIL with median age of 66 (range 42-82) years. The mean body mass index was 28.6 ± 0.7 kg/m(2); 54% and the majority had an American Society of Anesthesiologists classification of 3. The mean and median number of lymph nodes retrieved during surgery was 20 ± 1.4 and 18.5 respectively. R0 resections were achieved in all patients. Postoperative complications occurred in 14 (28%) patients, including atrial fibrillation in 5 (10%), pneumonia in 5 (10%), anastomotic leak in 1 (2%), conduit staple line leak in 1 (2%), and chyle leak in 2 (4%). The median ICU stay and length of hospitalization (LOH) were 2 and 9 days respectively. Total mean operating time calculated from time of skin incision to wound closure was 445 ± 85 minutes; however, operative times decreased over time. Similarly, there was a trend toward lower complications after the first 29 cases but this did not reach statistical significance. There were no in-hospital mortalities.
  
  
  CONCLUSIONS
  We demonstrated that RAIL for esophageal cancer can be performed safely and may be associated with fewer complications after a learning curve, shorter ICU stay, and LOH.
authors.affiliation: Division of Surgical Oncology, Florida Hospital Orlando, University of Central Florida, 2415 N. Orange Ave, Suite 400, Orlando, FL 32804, USA. Sebastian.delafuente.md@flhosp.org
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: de la Fuente
authors.forename: Jill
authors.initials: J
authors.lastname: Weber
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hoffe
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Richard
authors.initials: R
authors.lastname: Karl
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011183:Postoperative Complications; D012017:Referral and Consultation; D012189:Retrospective Studies; D012371:Robotics; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
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