Search

Additional file 1: Appendix Table 1. Risk of Bias Table. Appendix Table 2. ROBINS-I Table. Appendix Table 3. Pre-Post Risk of Bias Table. Appendix A. Search Strategy. Appendix B. Citations for Excluded Studies.

Key Points Question Are there differences in clinical outcomes with use of robot-assisted minimally invasive esophagectomy (RAMIE) compared with video-assisted minimally invasive esophagectomy (VAMIE) and open esophagectomy (OE) for cancer? Findings In this systematic review and meta-analysis of 21 articles including 9355 patients, RAMIE was associated with fewer pulmonary complications than VAMIE but had otherwise similar outcomes. Compared with OE, RAMIE was associated with increased operative time, decreased estimated blood loss, and fewer pulmonary and total complications. Meaning In this study, RAMIE was associated with fewer procedural complications; further work is needed to explore surgical approach and long-term oncologic outcomes., This systematic review and meta-analysis evaluates the literature for clinical outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) compared with video-assisted minimally invasive esophagectomy (VAMIE) and open esophagectomy (OE)., Importance The utilization of robot-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer is increasing, despite limited data comparing RAMIE with other surgical approaches. Objective To evaluate the literature for clinical outcomes of RAMIE compared with video-assisted minimally invasive esophagectomy (VAMIE) and open esophagectomy (OE). Data Sources A systematic search of PubMed, Cochrane, Ovid Medline, and Embase databases from January 1, 2013, to May 6, 2020, was performed. Study Selection Studies that compared RAMIE with VAMIE and/or OE for cancer were included. Data Extraction and Synthesis Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, data were extracted by independent reviewers. A random-effects meta-analysis of 9 propensity-matched studies was performed for the RAMIE vs VAMIE comparison only. A narrative synthesis of RAMIE vs VAMIE and OE was performed. Main Outcomes and Measures The outcomes of interest were intraoperative outcomes (ie, estimated blood loss [EBL], operative time, lymph node [LN] harvest), short-term outcomes (anastomotic leak, recurrent laryngeal nerve [RLN] palsy, pulmonary and total complications, and 90-day mortality), and long-term oncologic outcomes. Results Overall, 21 studies (2 randomized clinical trials, 11 propensity-matched studies, and 8 unmatched studies) with 9355 patients were included. A meta-analysis was performed with 9 propensity-matched studies comparing RAMIE with VAMIE. The random-effects pooled estimate found an adjusted risk difference (RD) of −0.06 (95% CI, −0.11 to −0.01) favoring fewer pulmonary complications with RAMIE. There was no evidence of differences between RAMIE and VAMIE in LN harvest (mean difference [MD], −1.1 LN; 95% CI, −2.45 to 0.25 LNs), anastomotic leak (RD, 0.0; 95% CI, −0.03 to 0.03), EBL (MD, −6.25 mL; 95% CI, −18.26 to 5.77 mL), RLN palsy (RD, 0.01; 95% CI, −0.08 to 0.10), total complications (RD, 0.05; 95% CI, −0.01 to 0.11), or 90-day mortality (RD, −0.01; 95% CI, −0.02 to 0.0). There was low certainty of evidence that RAMIE was associated with a longer disease-free survival compared with VAMIE. For OE comparisons (data not pooled), RAMIE was associated with a longer operative time, decreased EBL, and less pulmonary and total complications. Conclusions and Relevance In this study, RAMIE had similar outcomes as VAMIE but was associated with fewer pulmonary complications compared with VAMIE and OE. Studies on long-term functional and cancer outcomes are needed.

In this paper we pay homage to Dr Alan H. Adams, who was born on November 3, 1945, and passed away on December 26, 2020. An early adopter of problem-based learning and evidence-based medicine, he contributed substantially to improving chiropractic education, research, and developing an evidence-based practice mindset for chiropractic practice. People who knew Al best recall that he was a fluent instigator of collaborative relationships, and he inspired and advanced many people in their academic and scientific careers. His curiosity, expertise, and mentorship were appreciated by many people and developed numerous interprofessional collaborations.

Additional file 2: Supplemental Data Content 2. Evidence tables

Additional file 1: Supplemental Data Content 1. Search Strategies and Literature Flow

Additional file 4: Supplemental Data Content 4. Quality assessment for Included RCT Studies (cochrane risk of bias tool)

Additional file 5: Supplemental Data Content 5. Quality assessment for Included Observational Studies (ROBINS-i)

Additional file 7: Supplemental Data Content 7. Characteristics and Results of Prior Systematic Reviews Examining Robot-Assisted versus Laparoscopic Cholecystectomy Outcomes