Comparison of Short-term Outcomes Between Thoracoscopic and Robot-assisted Minimally Invasive Esophagectomy for...

Surgical approaches to esophageal cancer worldwide are shifting from open procedures to thoracoscopic esophagectomy (TE) and robot-assisted esophagectomy (RAE). However, whether RAE is superior to conventional TE has not been established. We compared short-term outcomes and oncological safety between TE and RAE.

We retrospectively reviewed 313 consecutive patients with esophageal cancer who were treated by minimally invasive TE (n=202) or RAE (n=111), then compared the surgical outcomes using propensity score-matched (PSM) analysis.

The total and thoracic surgical durations before PSM analysis were significantly longer (p=0.004 and p=0.03, respectively), and total and thoracic blood loss were significantly lower for RAE compared with TE (p=0.001 and p=0.01, respectively). Total surgical duration remained significantly longer (p=0.01), and total and thoracic blood loss were significantly lower when performing RAE, compared with TE (p=0.0003 and p=0.03, respectively) in 97 matched pairs of patients after PSM. Postoperative complications and the length of the postoperative of hospital stays did not significantly differ between the groups. C-reactive protein levels on postoperative days 1 and 2 were significantly lower for RAE than TE (p<0.001 and 0.002, respectively).

Although the surgical duration of RAE was longer, less blood was lost and the postoperative inflammatory response was reduced, while the number of dissected lymph nodes and postoperative complication rates were comparable. These findings suggest that RAE is a feasible and potentially less invasive surgical approach for esophageal cancer.