What type of study is this?

This is a Propensity Score Analysis study (also classified as: Observational).

September 10, 2025

Perioperative Outcomes in Robot-Assisted Esophagectomy at Our Institution: A Comparative Propensity Score Analysis of 360 Cases vs. Conventional Vats

Key Points

Robot-assisted minimally invasive esophagectomy showed improved blood loss outcomes compared to conventional methods.
The operative time was longer for robot-assisted procedures, averaging 200 minutes versus 185 minutes.
Pneumonia occurred less frequently in the robot-assisted group at 6.9% compared to 15.7% in conventional procedures.
Recurrence of laryngeal nerve palsy was lower in robot-assisted esophagectomy, but not statistically significant.

Abstract

Abstract Background Robot-assisted minimally invasive esophagectomy (RAMIE) has rapidly gained acceptance, offering tremor-free, multi-jointed instrument manipulation, which is particularly advantageous for upper mediastinal dissection. To evaluate the utility of RAMIE, we compared its outcomes with conventional minimally invasive esophagectomy (MIE) performed during the same period at our institution, using propensity score analysis. Methods At our institution, meticulous lymph node dissection around both recurrent laryngeal nerves is performed as a standard procedure regardless of the surgical approach. This study retrospectively analyzed 712 cases of thoracic esophageal cancer surgeries performed between April 2020 and December 2024. Among these, 712 cases underwent a transthoracic minimally invasive approach, excluding cases requiring recurrent laryngeal nerve resection. The analysis focused on 331 RAMIE cases and 381 MIE cases. Propensity score matching was used to adjust for variables such as age, gender, tumor location, ASA-PS, cT, cN, cM, and preoperative treatment. Short-term outcomes were then compared. Results After matching, 204 cases were included in each group. In short-term outcomes, the thoracic operative time was significantly longer in the RAMIE (200 min vs. 185 min, p 0.01), while blood loss was significantly lower in the RAMIE (123 mL vs. 173 mL, p 0.01). The incidence of recurrent laryngeal nerve palsy (Clavien-Dindo Grade ≥ 1) was lower in the RAMIE (13.7% vs. 20.1%, p = 0.113), though not statistically significant. Anastomotic leakage was observed in 3.4% of RAMIE cases compared to 8.3% of MIE cases (p = 0.056), and pneumonia was significantly less frequent in the RAMIE (6.9% vs. 15.7%, p 0.01). Conclusion RAMIE demonstrated superior short-term outcomes compared to MIE, suggesting that RAMIE is a highly effective surgical technique for esophageal cancer.

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