REVATE
Trial question
Is robot-assisted esophagectomy superior to video-assisted thoracoscopic esophagectomy in patients with esophageal SCC?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
9.0% female
91.0% male
N = 203
203 patients (19 female, 184 male).
Inclusion criteria: patients with esophageal SCC who were scheduled for minimally invasive McKeown esophagectomy.
Key exclusion criteria: previous major thoracic surgery preventing minimally invasive esophagectomy; history of second malignancy other than esophageal SCC; inability to comply with the follow-up schedule.
Interventions
N=103 robot-assisted esophagectomy (robotic-assisted esophagectomy with standard total two-field lymphadenectomy).
N=100 video-assisted thoracoscopic esophagectomy (thoracoscopic esophagectomy with standard total two-field lymphadenectomy).
Primary outcome
Successful left recurrent laryngeal nerve lymph node dissection
88.3%
69%
88.3 %
66.2 %
44.1 %
22.1 %
0.0 %
Robot-assisted
esophagectomy
Video-assisted thoracoscopic
esophagectomy
Significant
increase ▲
NNT = 5
Significant increase in successful left recurrent laryngeal nerve lymph node dissection (88.3% vs. 69%; RR 1.28, 95% CI 0.52 to 2.04).
Secondary outcomes
Significant decrease in median duration of operation, thoracic phase (110 minutes vs. 124 minutes; AD -14 minutes, 95% CI -23.23 to -4.77).
Significant increase in median number of mediastinal lymph node dissection (16 lymph nodes vs. 14 lymph nodes; AD 2 lymph nodes, 95% CI 0.14 to 3.86).
No significant difference in median duration of hospital stay (10 days vs. 11 days; AD -1 days, 95% CI -3.3 to 1.3).
Safety outcomes
No significant difference in major complications.
Conclusion
In patients with esophageal SCC who were scheduled for minimally invasive McKeown esophagectomy, robot-assisted esophagectomy was superior to video-assisted thoracoscopic esophagectomy with respect to successful left recurrent laryngeal nerve lymph node dissection.
Reference
Yin-Kai Chao, Zhigang Li, Hongjing Jiang et al. Multicentre randomized clinical trial on robot-assisted versus video-assisted thoracoscopic oesophagectomy (REVATE trial). Br J Surg. 2024 Jul 2;111(7):znae143.
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