Robotic Esophagectomy Compared with Open Esophagectomy Reduces Sarcopenia within the First Postoperative Year: A Propensity Score-matched Analysis
Menée en Allemagne à l'aide de données 2013-2020 portant sur 168 patients atteints d'un cancer de l'oesophage, cette étude analyse le risque de sarcopénie en fonction du type d'oesophagectomie effectué (mini-invasive assistée par robot ou par voie ouverte)
Introduction: Sarcopenia is a known risk factor for adverse outcomes after esophageal cancer (EC) surgery. RAMIE offers numerous advantages, including reduced morbidity and mortality. However, no evidence exists to date comparing the development of sarcopenia after RAMIE and OE. The objective was to evaluate whether the development of sarcopenia within the first postoperative year after esophagectomy is associated to the surgical approach: robot-assisted minimally invasive esophagectomy (RAMIE) vs. open esophagectomy (OE). Methods: 168 patients with EC were analyzed who either underwent totally robotic or fully open Ivor Lewis esophagectomy in a propensity score-matched analysis. Sarcopenia was assessed using the skeletal muscle index (SMI; cm2/m2) and psoas muscle thickness per height (PMTH; mm/m) on axial computed tomography (CT) scans during the first postoperative year; in total 540 CT scans were evaluated. Results: After 1:1 propensity score matching for confounders, 67 patients were allocated to RAMIE and OE groups, respectively. SMI in OE group was significantly lower compared to RAMIE group at the third (43.2 ±7.6 cm2/m2 vs. 49.1 ±6.9 cm2/m2, p=0.001), sixth (42.7 ±7.8 cm2/m2 vs. 51.5 ±8.2 cm2/m2, p<0.001) and ninth (43.0 ±7. cm2/m2 vs. 49.9 ±6.6 cm2/m2, p=0.015) postoperative month. Similar results were recorded for PMTH. Conclusions: This study is the first to suggest a significant benefit of RAMIE compared to open esophagectomy in terms of postoperative sarcopenia. These results add further evidence to support implementation of the robotic approach in multimodal therapy of esophageal cancer.