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Background: Compression of the celiac artery by the median arcuate ligament results in median arcuate ligament syndrome (MALS). Using a consecutive cohort of patients with MALS, this study evaluated the efficacy and safety of robotic median arcuate ligament release (MALR). Methods: A retrospective chart review was performed on patients who underwent robotic MALR from August 2012 to April 2018. Patient workup included history and physical examination, mesenteric Doppler ultrasound, and CT (Computed Tomography) scan. Outcomes included pain improvement, length of stay, operation duration, narcotic use, and postoperative complications. Results: Twenty-seven patients met inclusion criteria. Two thirds of the cohort were female and the mean age was 49 ± 15.5 years. Postprandial abdominal pain was the most common preoperative symptom (25/27, 93%). CT (Computed Tomography) was performed in 24 (89%), and celiac stenosis > 70% was observed in all. Operative duration was 95 minutes on average (range, 53–358 minutes), and in 24/27 (89%) patients, estimated blood loss was < 100 mL. Eighty-one percent of patients were discharged the day of surgery (22/27). Two cases were converted to open, with only one major complication occurring. At 30 or more days postoperation, 17 patients (68%) had full, 1 (4%) partial, and 1 (4%) no symptom resolution, 6 (24%) had symptom recurrence after initially having resolution. Fifty-six percent achieved narcotic liberation 9/16 (56%). Conclusions: Robotic MALR is a safe option for treatment of MALS with high response rates, early hospital discharge, and opportunity for narcotic liberation.

Introduction: Sarcopenia has been identified as a potential predictive variable for outcomes in selective surgical procedures and disease processes. The benefit of using sarcopenia for such purposes in oncologic surgery remains unclear. Methods: A retrospective review was conducted for all patients undergoing resection of esophageal adenocarcinoma with intention for cure at a single institution from 2006-2012. Lean psoas muscle area (LPMA) and LMPA/ BMI were calculated at the level of the L4 vertebral body using preoperative computed tomography correcting for muscle density. Patients were analyzed in tertiles based on these measurements. The primary outcome measures were anastomotic leak, 90-day morbidity (Clavien grade ≥ 3), and long-term overall survival. Multivariate analyses were performed for the primary outcome measures. A p value < 0.05 was considered significant. Results: One hundred six consecutive patients were identified and 100 patients had preoperative CT scans available for review. The mean patient age was 63±11 and 62% underwent neoadjuvant therapy. All surgical procedures were performed open and approaches included transhiatal (76%), Ivor-Lewis (11%), and three-field (13%) esophagectomy. The anastomotic leak rate was 10% and 90-day morbidity rate was 38%. Neither LPMA nor LPMA/BMI were significant predictors of anastomotic leak (LMPA p=0.503; LPMA/BMI p=0.268) or morbidity (LPMA p=0.787; LPMA/BMI p=0.528). Median overall survival was 2.8 years. Tertiles for LPMA (p=0.210) and LPMA/BMI (p=0.409) were not predictive of long-term survival (Fig. 1,2). Conclusion: Sarcopenia is not predictive of short term outcomes or longterm overall survival following esophagectomy for esophageal adenocarcinoma.