Short-term outcomes of robot-assisted versus conventional thoracoscopic esophagectomy: a nationwide inpatient...

Although the clinical application of robot-assisted esophagectomy (RE) has increased globally, its advantages over conventional thoracoscopic esophagectomy (TE) remain unclear. The aim of this study was to evaluate the short-term outcomes of RE compared with TE in patients with esophageal cancer in a nationwide cohort.

We retrospectively analyzed patients who underwent RE or TE for esophageal cancer between April 2018 and March 2022 by extracting data from the Diagnosis Procedure Combination, a Japanese national inpatient database. Instrumental variable analysis was employed to compare the short-term outcomes between the two groups. The primary outcomes included respiratory complications and unplanned reintubation.

Among 7003 eligible patients from 69 hospitals, 1971 (28.1%) and 5032 (71.9%) underwent RE and TE, respectively. Respiratory complications, unplanned reintubation, and anastomotic leakage occurred in 1501 (21.4%), 475 (6.8%), and 904 patients (12.9%), respectively. Instrumental variable analysis demonstrated that the incidence of respiratory complications [odds ratio 0.65 (95% CI: 0.52-0.81) P < 0.001], unplanned reintubation [0.44 (0.31-0.62) P < 0.001], and anastomotic leakage [0.73 (0.56-0.94) P = 0.013] was significantly lower in the RE group compared with the TE group.

RE was associated with better short-term outcomes, including fewer respiratory complications, unplanned reintubation, and anastomotic leakage, compared with TE.