Quality and safety of Ireland's first robotic oesophagectomy program

Oesophageal cancer incidence is rising, with a concurrent increase in oesophagectomy as neoadjuvant and perioperative therapies improve. Oesophagectomy remains the cornerstone of curative treatment. The adoption of robotic-assisted surgery (RAS) in oesophagectomy has been slow, with concerns regarding the learning curve and safety. This series describes the safe introduction of RAS for oesophagectomy in Ireland.

A review of prospectively maintained data from a single surgeon was performed, encompassing the period from February 2016 to December 2024. Standard clinicopathological variables were extracted. The RAS program (using DaVinci X/Xi) for oesophagectomy began in March 2020. Operations were classified as open, hybrid, minimally invasive, RAS-hybrid, or totally RAS. Length of stay (LOS), margin status, nodal yield, perioperative complications, and mortality were compared, as well as ERAS outcomes, where applicable.

A total of 198 patients underwent oesophagectomy; 93 underwent RAS (52 total RAS, 41 hybrid). Demographics were comparable between RAS and non-RAS groups. There was an improvement in nodal yield for the total-RAS patients compared to non-RAS patients (mean 27.8, SD 8.7 vs 23.2, SD 9.1; p = 0.1). There was no difference in margin status (p = 0.55), overall complications (p = 0.23), LOS (p = 0.31), or 90-day mortality (p = 0.85) between RAS and non-RAS groups. The anastomotic leak rate was 3% for RAS versus 10% for non-RAS (p = 0.08). The chyle leak rate increased with RAS (22% vs 10%, p = 0.01), although this decrease was observed over time. R0 resection rate was comparable for RAS and non-RAS (90% vs 91% p = 0.55).

RAS oesophagectomy can be introduced safely for experienced RAS surgeons. Early in the learning curve, similar perioperative outcomes occur, with no significant increase in overall complications. RAS has the potential to improve oncologic outcomes.