Robot-assisted laparoscopic management of XXXX according to Siewert recommendations.

@entity1 @entity5 @entity190 @entity254 @entity189 @entity418 @entity204 @entity356
BACKGROUND: Resection of @entity418 and upper @entity356 is considered a demanding procedure in laparoscopic surgery. Robotics could aid laparoscopic dissection of the oesophago-gastric junction and oesophageal @entity254 , enlarging indications for a minimally invasive approach to these @entity5 . METHODS: Data from 17 consecutive @entity1 with histologically proved @entity189 were collected in a prospective database to assess the feasibility and safety of laparoscopic robot-assisted radical surgery, using the four-arm da Vinci surgical system. The type of surgery was chosen according to Siewert recommendations. Outcome measures were conversion rate, intra- and post-operative morbidity and mortality, operative time, @entity190 , number of lymph nodes harvested and macroscopic and microscopic evaluation of resection margins. RESULTS: Seventeen laparoscopic operations were completed without conversion (14 extended gastrectomies, two transhiatal distal oesophagectomies and one transthoracic distal oesophagectomy). Extended lymph node dissection and oesophago-jejunal @entity254 were successfully carried out using the da Vinci system. Mean operative time was 327.2    93.4 min and @entity190 279    199 ml. The mean number of nodes retrieved was 28    9 and all resection margins were negative. There was no mortality and overall morbidity was acceptably low (41.1%). During a mean follow-up time of 20 months, four recurrences were recorded (two multivisceral, one to the lung and one nodal), with two recurrence-related @entity204 . CONCLUSIONS: Robot-assisted laparoscopic radical surgery of the oesophago-gastric junction is feasible and safe. Longer follow-up time and randomized studies are needed to evaluate the long-term outcome and advantages for the @entity1 of this new technology.
