title: The Oncologic Outcome of Esophageal Squamous Cell Carcinoma Patients After Robot-Assisted Thoracoscopic Esophagectomy With Total Mediastinal Lymphadenectomy.
abstract: BACKGROUND
  The oncologic outcome of esophageal squamous cell carcinoma (ESCC) patients after robot-assisted thoracoscopic esophagectomy (RATE) with total mediastinal lymphadenectomy (ML) has not been reported. This study was performed to determine the oncologic outcome of RATE and the effectiveness of total ML for ESCC.
  
  
  METHODS
  The 115 patients who underwent RATE without neoadjuvant therapy from 2006 to 2014 were reviewed. The efficacy index (EI) was calculated by multiplying the incidence of metastasis by the 3-year survival rate of the patients for each node station.
  
  
  RESULTS
  The majority of patients were male (92.2%), and the mean age was 63.2 ± 0.8 years. Tumor location was the upper esophagus in 12 patients (10.4%), the middle esophagus in 59 patients (51.3%), and the lower esophagus in 44 patients (38.3%). R0 resection was achieved in 110 (95.7%) patients; the mean number of dissected nodes was 49.0 ± 1.9. Operative mortalities were 4 (3.5%) cases; in the remaining 111 patients, the mean follow-up time was 32.4 ± 2.2 months. Overall survival (OS) and recurrence-free interval (RFI) at 3 years were 85.0% and 79.4%, respectively. The 3-year OS and RFI were 94.4% and 96.2% in patients with stage I disease, 86.2% and 80.1% in stage II disease, and 77.8% and 79.5% in stage IIIA disease, respectively. High EI values were determined in the bilateral recurrent laryngeal nerve (RLN) nodes in upper and middle ESCC, and in the left gastric and paracardial nodes in lower ESCC.
  
  
  CONCLUSIONS
  The oncologic outcome of RATE was acceptable. Total ML, including dissection of the RLN nodes, is recommended especially in upper or middle ESCC.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seong Yong
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: kdjcool@yuhs.ac.
authors.forename: Dae Joon
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Do
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jeewon
authors.initials: J
authors.lastname: Suh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seokkee
authors.initials: S
authors.lastname: Lee
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016019:Survival Analysis