Comparison of Clinical Outcomes Between Robot-Assisted Esophagectomy With Total Mesoesophageal Excision and Conventional Minimally Invasive Esophagectomy for Esophageal Cancer

Abstract

BACKGROUND: This study aimed to evaluate the clinical value of robot-assisted surgery combined with the total mesoesophageal excision (TME) for resectable esophageal cancer and to compare its advantages over conventional minimally invasive esophagectomy (MIE) and non-mesoesophageal esophagectomy. METHODS: The study retrospectively analyzed data from 159 patients who underwent McKeown esophagectomy at 2 provincial tertiary hospitals (January 2019-March 2025). The patients were stratified into 4 groups based on surgical approach, including robot-assisted total mesoesophageal esophagectomy (RATME, n = 38), robot-assisted conventional minimally invasive esophagectomy (RAMIE, n = 37), video-assisted thoracoscopic total mesoesophageal esophagectomy (VATME, n = 42), and video-assisted minimally invasive esophagectomy (VAMIE, n = 42). The analysis compared baseline characteristics, perioperative data, and survival outcomes among groups. RESULTS: The RATME group had a significantly longer operative time than the other groups (P < 0.01). However, it demonstrated significant reductions in intraoperative blood loss and thoracic drainage volume within the first 48 h postoperatively (P < 0.05), together with a shorter postoperative hospital stay. Compared with the non-mesoesophageal group, the mesoesophageal group had significantly more harvested lymph nodes (P < 0.05) and a lower overall incidence of postoperative complications (P < 0.05). No statistically significant differences were observed in overall survival (OS) or disease-free survival (DFS) among the 4 groups. The incidence of recurrence and death events was lower in the RATME group. CONCLUSION: Robot-assisted total mesoesophageal esophagectomy (RATME) could be a safe technique. Integrating mesoesophagus theory with robotic surgery achieved superior perioperative outcomes, including reduced intraoperative bleeding, increased lymph nodes dissected, lower complication rates, and accelerated recovery, and it may bring about a better long-term outcome.