Achieving textbook outcomes with robotic-assisted Ivor Lewis esophagectomy: a single-center experience with 150...

With published randomized data, minimally invasive esophagectomy (MIE) has become increasingly popular. However, substantial variability in techniques and outcomes still exists.

This was a retrospective analysis of 150 consecutive robotic-assisted MIEs (RAMIEs) from a prospectively maintained database from 2020 to 2024 at a single comprehensive cancer center. This study aimed to evaluate the textbook outcome rates after RAMIE.

A total of 150 consecutive patients underwent RAMIE from 2020 to 2024. Tumor location included the esophagus in 18 patients, type 1 gastroesophageal junction (GEJ) in 52 patients, type 2 GEJ in 71 patients, and type 3 GEJ in 9 patients. Most patients had clinical stage T3 tumors. Neoadjuvant therapy was used in 85% of the patients. A complete pathologic response was observed in 27% of patients. The median number of lymph nodes retrieved was 21. Anastomotic leak occurred in 2 patients, none of whom required reoperation. The median hospital stay duration was 7 days. The 30- and 90-day mortality rates were 0.7% and 1.3%, respectively. In addition, the 90-day stricture rate after endoscopic dilation was 0.7%. Of note, 90% of patients had a textbook outcome.

This single-center experience highlights that the combination of a robotic platform and a side-to-side stapled anastomotic technique helps achieve exceptional postoperative outcomes for MIE, with a textbook outcome rate of 90%. With the increasing worldwide adoption of MIE, this seems to be an appropriate time to standardize operative techniques to optimize postoperative outcomes.