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September 10, 2025

Short-Term Results of Transcervical Mediastinoscopic and Transabdominal Robotic Esophagectomy (Mare) for All Cases of Esophageal Cancer

Key Points

Robotic esophagectomy shows similar safety profiles to traditional techniques in esophageal cancer cases.
Average operative time for robotic esophagectomy was 546 minutes, with an overall complication rate of 35%.
Retrospective analysis included 176 cases, with MARE and ME groups both consisting of 88 patients.
As surgery techniques evolve, minimally invasive methods like MARE could minimize chest wounds and improve patient outcomes.

Abstract

Abstract Background Minimally invasive surgery and reduction of postoperative complications have been shown to be associated with long-term outcomes. At our hospital, mediastinoscopic esophagectomy has been the first choice for minimally invasive and complication-reducing procedures. In addition, to further improve the precision of the procedure for highly advanced localized cancer, we have decided to use continuous neuromonitoring and robotics for all patients starting in April 2023. However, the safety of robotic mediastinoscopy (transcervical mediastinoscopic and transabdominal robotic esophagectomy; MARE) for all esophageal cancers is unknown. Methods To investigate the short-term results of MARE and verify its safety and feasibility, we retrospectively observed non-robotic mediastinoscopic esophagectomy (ME) and MARE. 176 total cases were investigated from 4/1/2018 to 12/1/2024, excluding 13 cases in which total pharyngolaryngectomy was also performed. A total of 176 cases were included in the analysis. Results As a result, there were 88 patients in the MARE group and 88 in the ME group. cT1/2/3/4 were 18/6/42/22 and 31/10/37/9 each, cStage 0/I/II/IIIAB/IVAB were 4/13/14/35/22 and 8/15/24/31/10 cases, respectively. The estimated average operative time was 546 and 520 minutes, blood loss 111 and 286 mL, and overall complication rates were 35% and 38% for CD-II and higher, and 20% and 14% for CD-IIIa and higher. Median postoperative hospital stay was 12 and 14 days, open conversion rate 0% and 1.1%, pathologic R0 resection rate 92% and 95%, and number of lymph nodes dissected 51.9 and 47.1. Conclusion MARE was considered to be as safe to complete as ME. Since the previously reported complication rate of CD-IIIa or higher for thoracoscopic esophagectomy is around 22%, MARE and ME could be safely performed even for local highly advanced cancer. Since the number of very elderly patients and patients with low pulmonary function will continue to increase, MARE and ME with zero chest wounds are considered a promising surgical technique for the future. Since the number of institutions adopting mediastinoscopy is gradually increasing in Japan, this technique is expected to advance to the stage of widespread use in the future.

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