Short-and Long-Term Outcomes of Robot Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Propensity Score-Matched Study

Abstract Background Conventional minimally invasive esophagectomy (C-MIE) for esophageal cancer has become widespread and standardized. In Japan, robot-assisted MIE (RAMIE) has been covered by national health insurance since 2018. However, the superiority of RAMIE over conventional MIE remains controversial. In this study, we will clarify the short-and long-term outcomes of RAMIE compared to C-MIE. Methods Short-term outcomes were compared using propensity score-matching (PSM) for C-MIE group (324 cases) and RAMIE group (101 cases) performed from 2010 to 2023. Long-term outcomes were compared using PSM for C-MIE group (313 cases) and RAMIE group (69 cases) up to 2021, when a minimum three-year observation period was available. Covariates for PSM were age, sex, tumor location, histological type, cT, cN, preoperative treatment, abdominal approach, and range of lymph node dissection. Results For short-term outcomes, 96 cases were included in each group after PSM. There were no significant differences in age, sex, tumor location, histological type, cT, cN, and preoperative treatment. Operative time was significantly longer in RAMIE group than in C-MIE group (overall procedure: 657 vs. 764 min, P0.001; thoracic prpcedure: 306 vs. 411 min, P0.001). Blood loss was significantly lower in RAMIE group than in C-MIE group (145 vs. 64 ml, P0.001). The rate of recurrent laryngeal nerve palsy (Clavien-Dindo classification, Grade II or higher) was significantly lower in RAMIE group than in C-MIE group (10% vs. 0%, P0.001). There were no significant differences in the rates of anastomotic leakage and postoperative pneumonia between both groups (P=0.159, 0.709). For long-term outcomes, 69 cases were included in each group after PSM. The 3-year overall survival rate was 70.8% in C-MIE group and 77.1% in RAMIE group, and the 3-year disease-free survival rate was 63.5% in C-MIE group and 58.8% in RAMIE group, both showing no significant difference (P=0.406, P=0.651). Conclusions RAMIE has the potential to reduce recurrent laryngeal nerve palsy compared to C-MIE and long-term outcomes for both procedures were comparable.