100th robotic Ivor Lewis esophagectomy: Important milestone for complex procedure

Roswell Park’s Moshim Kukar, MD, recently completed his 100^th robotic Ivor Lewis esophagectomy, an important milestone for this complex procedure. While robotic surgery is increasingly common for other types of operations, few centers have the surgical qualification and high-volume experience to offer robotic surgery for these difficult procedures for cancers involving the esophagus and gastroesophageal junction.

The Ivor Lewis esophagectomy, the most common operation for treating tumors in the lower esophagus and the gastroesophageal junction, removes the lower portion of the esophagus and upper portion of the stomach, constructs a gastric conduit from a part of the remaining stomach, and reconnects it to the esophagus. Roswell Park performs 60 to 70 esophagectomies a year — nearly three times the 25 per year that signifies a high-volume facility. Roswell Park’s surgical team led by Moshim Kukar, MD, FACS, has performed over 500 minimally invasive esophagectomies since 2012, and used robotic surgery for all esophagectomies exclusively since 2018, with more than 150 total robotic esophagectomy procedures.

Their group has published excellent outcomes utilizing a minimally invasive approach and a side-to-side stapled anastomoses that leads to low leak and stricture rates and soon-to-publish robotic assisted surgery outcomes data show even lower complication rates, such as an anastomotic leak rate of 2% (compared to national average of 8 to 10%) and 0% 30-day mortality (compared to 3 to 5% national average).

The success of this program stems from a true multidisciplinary approach, close collaboration with our thoracic surgery colleagues Sai Yendamuri, MD, MBA, FACS, and Todd Demmy, MD, FACS, the ability to offer different approaches to surgery tailoring to patient needs, a robust care coordination team and standardized postoperative care pathways.

Bringing surgical excellence and the precision of robot assistance to the Ivor Lewis procedure is a game-changer for the patient. By performing these complex procedures robotically, resulting in a less invasive operation, speedier recovery and reduced complications (most do not need intensive care and are up walking the next day), our patients are able to begin subsequent systemic therapy sooner, specifically recently approved immunotherapy that minimizes cancer recurrences and leads to higher cure rates.