Fully Robotic Ivor-Lewis Esophagectomy Versus Hybrid Robotic Esophagectomy-A Review and Meta-Analysis of the Clinical...

Background: Esophageal cancer ranks among the top ten most prevalent cancers worldwide and remains a significant contributor to cancer-related mortality. While surgery combined with neoadjuvant therapy stands as the cornerstone treatment, the evolution of surgical techniques towards minimally invasive procedures has shown promising results. Robotic Assisted Minimally Invasive Esophagectomy (RAMIE) emerges as a potential advancement, offering precise movements and a three-dimensional endoscopic view. Against this backdrop, clarifying whether a fully robotic approach provides measurable perioperative or early oncologic advantages over a hybrid technique is clinically relevant. Despite initial skepticism, studies comparing fully robotic and hybrid approaches for esophagectomy have been conducted to evaluate their feasibility and sustainability. Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. Four retrospective studies comparing fully robotic and hybrid approaches were included, comprising 1540 patients. Results: Intraoperative outcomes favored the fully robotic approach, showing shorter operative times and reduced blood loss (MD = -41 min, p = 0.056, 95% CI: -83.202; 0.994 and MD = -48.762 mL, p = 0.040, 95% CI: -95.257; -2.266, respectively). Additionally, the fully robotic approach demonstrated advantages in terms of lymph node retrieval and shorter ICU and hospital stay (MD = -0.894, p < 0.0001, 95% CI: -1.224; -0.564, MD = -1.139 days, p < 0.0001, 95% CI: -1.313; -0.965 and MD = -3.264 days, p = 0.011, 95% CI: -5.767; -0.760, respectively). Conclusions: Although limitations exist, including the retrospective nature of the studies and limited sample size, the findings suggest that the fully robotic approach may offer superior outcomes compared to the hybrid approach for Ivor-Lewis esophagectomy. These results highlight the potential of robotics in enhancing safety and effectiveness in oesophageal cancer surgery, encouraging further consideration and adoption by surgeons.