Robotic-assisted versus conventional minimally invasive esophagectomy: a retrospective cohort study from a high-volume center

Abstract

As a newer surgical technique, robotic-assisted minimally invasive esophagectomy (RAMIE) offers an alternative to conventional minimally invasive esophagectomy (cMIE) in the treatment of esophageal cancer. The objective of this study was to evaluate and compare postoperative outcomes of RAMIE versus cMIE in patients undergoing Ivor-Lewis esophagectomy at a high-volume institution. The medical records from patients who underwent minimally invasive Ivor-Lewis esophagectomy between 2015 and 2024 were retrospectively analyzed. Data on surgical and oncological outcomes, such as conversions to open surgery, lymph node yield, anastomotic leakage rates, postoperative complications, and mortality, were collected and evaluated. The analysis included a total of 250 patients: 170 underwent cMIE, and 80 underwent RAMIE. Patient baseline characteristics were comparable across both groups, except for differences in neoadjuvant therapy use. Importantly, no mortality was recorded within 30- or 90-day following RAMIE, and conversion rates were low in both cohorts. The rates of anastomotic leaks, major postoperative complications, and harvested lymph nodes were comparable across the two groups. Additionally, multivariable logistic regression analysis controlling for potential confounders confirmed that RAMIE and cMIE had similar leak rates. The current findings indicate that RAMIE represents a safe, feasible option comparable to cMIE, with potential ergonomic advantages and improved postoperative recovery. However, additional studies in larger groups will be necessary to validate these findings and determine long-term oncologic outcomes.