P1.203. Evaluation of the Usefulness of Robot-Assisted Esophagectomy Compared to Thoracoscopic Esophagectomy

Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Following the results of the JCOG1409 trial, thoracoscopic esophagectomy has become the standard treatment for esophageal cancer. However, the introduction of robot-assisted esophagectomy is expected to further reduce postoperative complications and potentially improve long-term outcomes. Methods We retrospectively analyzed 328 consecutive patients who underwent minimally invasive esophagectomy with gastric conduit reconstruction for thoracic esophageal cancer or esophagogastric junction cancer at our institution between January 2017 and September 2025. Patients were divided into two groups: thoracoscopic esophagectomy (Group A) and robot-assisted esophagectomy (Group B). Short-term outcomes were compared between the two groups. Results Of the 328 patients, 170 (51.8%) were in Group A and 158 (48.2%) in Group B. There were no significant differences in baseline characteristics, including median age (A vs. B: 69 vs. 70 years) and sex (male/female: 153/17 vs. 137/21). Perioperative factors (A vs. B) showed no significant differences in median operative time (537.5 vs. 548.5 minutes) or median blood loss (148 vs. 131 mL). Postoperative complications were also comparable: pneumonia (CD grade ≥2) occurred in 23 patients (13.5%) vs. 16 patients (10.1%), and anastomotic leakage (CD grade ≥2) occurred in 18 (10.6%) vs. 23 (14.6%) in Groups A and B, respectively. Recurrent laryngeal nerve palsy was significantly less frequent in Group B, both for CD grade ≥1 (18 [10.6%] vs. 7 [4.4%], p=0.036) and CD grade ≥2 (7 [4.1%] vs. 1 [0.6%], p=0.041). The median postoperative hospital stay was 23 days in both groups, with no significant difference. Conclusion Robot-assisted esophagectomy may significantly reduce the incidence of recurrent laryngeal nerve palsy. A randomized controlled trial is currently ongoing to further validate these findings and generate robust evidence.