Esophago-gastrectomy has historically been associated with high morbidity and mortality rates. Minimally invasive surgery has been proposed as a solution to this problem. There has been a rapid adoption of robotic-assisted minimally invasive esophagectomy, despite concerns regarding the published morbidity and anastomotic leak rates. We present outcomes from our unit's experience of two-phase (Ivor Lewis) esophago-gastrectomies, from Open through Hybrid, and our first 170 Robotic-Assisted Ivor Lewis esophago-gastrectomy (RAILE) cases. This retrospective cohort study investigated our experience in a single UK institution from 2017 to 2025. We analyzed our prospectively maintained database for patients undergoing two-phase transthoracic esophagectomy for oncological reasons. The study was divided into three consecutive cohorts: Open (n = 100), Hybrid (n = 82), and RAILE (n = 170). No significant differences were observed in patient demographics or tumor stage between the groups. Comparison of Open vs. Hybrid vs. RAILE demonstrated a significant reduction in major complications (Clavien-Dindo ≥IIIb), 20.0% vs. 12.2% vs. 8.8% (P = 0.0289); pulmonary complications, 36.0% vs. 25.6% vs. 17.1% (P = 0.0021); and median length of hospital stay, 14 vs. 12 vs. 8 days (P ≤ 0.0001). Comparison of Open vs. Hybrid vs. RAILE demonstrated a significant reduction in anastomotic leak rate, 12.0% vs. 2.4% vs. 4.1%, respectively (P = 0.0094). Median lymph node yields were comparable across the groups, 48 vs. 43 vs. 41 (P = 0.1871). This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAILE for esophagectomy. These findings have important patient and resource implications that support the continued evaluation of RAILE.
Rayner et al. (Wed,) studied this question.