Surgical Outcomes of Hybrid-Robotic Compared with Non-Robotic Oncological Esophagectomy for Adenocarcinoma Using a...

Background: Ivor Lewis esophagectomy for esophageal malignancies is a core element of the treatment but still comes with substantial postoperative complications. Especially within the learning curve of robotic esophagectomy, an optimal treatment pathway is crucial to minimize the clinical impact of this phase. This study aimed to compare the surgical outcomes of hybrid-robotic esophagectomy for adenocarcinoma of the esophagus with non-robotic procedures using a fail-safe protocol. Methods: This retrospective single-center study evaluated the outcome of hybrid-robotic procedures within the early robotic learning curve in comparison to a historical control group of laparoscopic and open non-robotic procedures using uni- and multivariable regression analysis. CUSUM analysis was applied for learning curve outcomes. All procedures were performed between January 2016 and December 2025 within a standardized fail-safe approach. The primary end point was the occurrence of anastomotic leakage (AL), whereas the overall complications as well as the number of harvested lymph nodes were secondary end points. Results: A total of 156 patients were analyzed, including 50 hybrid-robotic and 106 non-robotic resections. Robotic surgery was associated with a higher lymph node yield (40.9 ± 11.0 vs. 35.7 ± 13.1; p = 0.011) and a lower lymph node ratio (0.085 vs. 0.125; p = 0.046). The AL rate was 4.0% in the robotic group and 5.7% in the non-robotic group. Length of stay was significantly shorter after robotic procedures (13.1 ± 5.5 vs. 18.6 ± 11.3 days; p < 0.001). Conclusions: Establishing a robotic esophagectomy program within an established structured fail-safe protocol was not associated with an increased risk of anastomotic leakage or major complications. Within this standardized setting, an increased lymph node yield, potentially optimizing oncological quality was observed. These findings indicate that acceptable preoperative safety and oncological outcomes can be achieved even during the learning curve of hybrid-robotic esophagectomy embedded in a structured fail-safe protocol.