title: Outcomes of robotic-assisted transhiatal esophagectomy for esophageal cancer after neoadjuvant chemoradiation.
abstract: BACKGROUND
  We previously reported our experience performing robotic-assisted transhiatal esophagectomy (RATE) in patients with early-stage esophageal cancer who had had no preoperative treatment. The purpose of this report was to determine if RATE could be performed safely with good outcomes for esophageal cancer in a more recent series of patients, the majority of whom were treated with neoadjuvant chemoradiation.
  
  
  METHODS
  This was a retrospective review of patients with adenocarcinoma of the distal esophagus or gastroesophageal junction who underwent RATE between November 2006 and November 2012 at a single tertiary-care hospital. Main outcome measures included operative and oncologic parameters, morbidity, and mortality.
  
  
  RESULTS
  In total, 23 patients underwent RATE, consisting of 20 men and 3 women with a median age of 64 years (range, 40-81 years). The majority of patients (19/23 [83%]) underwent neoadjuvant chemoradiation, although 1 patient had preoperative chemotherapy only, and 3 patients went straight to surgery. Median operative time was 231 minutes (range, 179-319 minutes), and median estimated blood loss was 100 mL (range, 25-400 mL). There were no conversions to open surgery. Complications included seven strictures, two anastomotic leaks, and two pericardial/pleural effusions requiring drainage. One patient required pyloroplasty 3 months after esophagectomy. One patient died from pulmonary failure 21 days after surgery (30-day mortality rate of 4%). The median length of stay was 9 days (range, 7-37 days). Seven of the 19 patients who underwent preoperative chemoradiation had a complete response on final pathology. The mean lymph node yield was 15 (range, 5-29), and surgical margins were negative for cancer in 21 cases.
  
  
  CONCLUSIONS
  RATE can be performed safely with good oncologic outcomes following neoadjuvant chemoradiation in patients with esophageal cancer. This technique has become our choice of operation for most patients with esophageal cancer.
authors.affiliation: Department of Surgery, University of California San Diego , La Jolla, California.
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Coker
authors.forename: Juan S
authors.initials: JS
authors.lastname: Barajas-Gamboa
authors.forename: Joslin
authors.initials: J
authors.lastname: Cheverie
authors.forename: Garth R
authors.initials: GR
authors.lastname: Jacobsen
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Sandler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
authors.forename: Michael
authors.initials: M
authors.lastname: Bouvet
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D059186:Chemoradiotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome