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Comparison of Short-Term Outcomes Between Robot-Assisted and Conventional Mediastinoscopic Esophagectomies: A
Takashi Mitsui1, Hiroto Kawabata2, Yuhei Hakozaki2
1Department of Surgery, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, Koshigaya, Saitama, Japan. mitsuitakashi3@gmail.com.
Annals of Surgical Oncology
|December 22, 2025
Summary
Robot-assisted mediastinoscopic esophagectomy (RA-ME) significantly reduces the risk of recurrent laryngeal nerve palsy and blood loss in esophageal cancer surgery. This minimally invasive technique shows promise for improving patient outcomes.
Area of Science:
- Minimally invasive surgery
- Surgical oncology
- Robotic surgery
Background:
- Mediastinoscopic esophagectomy (ME) is a minimally invasive approach for esophageal cancer.
- A key challenge in ME is the high incidence of left recurrent laryngeal nerve palsy (RLNP).
- A novel transcervical mediastinoscopic and transabdominal robot-assisted esophagectomy (RA-ME) technique was developed to mitigate this risk.
Purpose of the Study:
- To evaluate the clinical significance of robotic assistance in ME.
- To compare the incidence of RLNP between RA-ME and conventional ME (Co-ME).
- To assess secondary outcomes including operative time, blood loss, complications, and oncologic results.
Main Methods:
- Retrospective review of patients undergoing ME for esophageal or esophagogastric junction cancer (April 2018 - March 2025).
- Propensity score matching (PSM) was used to create comparable groups (68 pairs, n=136).
- Primary endpoint: incidence of left RLNP; Secondary endpoints: operative time, blood loss, complications, lymph node yield, R0 resection rate.
Main Results:
- RA-ME group showed a significantly lower RLNP incidence (19.1% vs. 38.2%, p=0.022).
- RA-ME resulted in significantly less intraoperative blood loss (99.8 mL vs. 251.0 mL, p=0.001).
- Operative time, complication rates, lymph node yield, and R0 resection rates were comparable between groups.
Conclusions:
- RA-ME significantly reduces RLNP incidence and intraoperative blood loss in minimally invasive esophageal cancer surgery.
- Robotic assistance does not compromise oncologic outcomes.
- RA-ME represents a promising standard approach for select patients undergoing minimally invasive esophagectomy.
