PD08.05. Short - and Long-Term Outcomes of Robot-Assisted Versus Video-Assisted Thoracoscopic Esophagectomy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer In order to achieve a radical lymph node dissection, we introduced the transthoracic minimally invasive esophagectomy (TMIE) with hybrid position and TMIE with extensive lymph node dissection have been routinely conducted. We previously reported the survival advantage in video assisted (VA) TMIE (Br J Surg 2020). TMIE has been adopted in robotic (RA) TMIE, and we previously reported that RA-TMIE resulted in improved postoperative swallowing function and shorter postoperative hospital stay (Asian J Endosc Surg 2022). To evaluate the clinical significance of RA-TMIE, treatment outcomes in short and long terms need to be assessed compared to VA-TMIE. Analysis 1: Four hundreds and five patients with esophageal cancer who underwent either VA or RA-TMIE between 2009 and 2023 were retrospectively reviewed. Clavien-Dindo Classification (C-D) based on postoperative complications, overall survival, recurrence free survival, and pattern of recurrence were evaluated. Analysis 2: One hundred and thirty-six patients with esophageal cancer who underwent RA-TMIE between 2018 and 2025 were retrospectively reviewed. Postoperative complications were reviewed. Analysis 1: Of 405 patients, cStage I/II/III/IV was 185(46%)/83(20%)/112(28%)/25(6%), and VA/RA was 347/58, respectively. The incidence rate of RLNP in VA/RA (≥C-D II) was comparable (VA/RA, 26(7.5%)/5(8.6%), p=0.79). The incidence of pneumonia (≥C-D II) was tended to be lower in RA (VA/RA, 63(18%)/7(12%), p=0.38). In survival analysis, the 3 years RFS rate in VA/RA was 64%/62%, respectively. Analysis 2: The incidence rate of RLNP(≥C-D II) was gradually decreased after standardization of the surgical procedure (9.6%→2.4%, p=0.11). In RA-TMIE, a decreasing trend of RLNP was observed over time after standardization of the surgical procedure. Considering that survival outcome was comparable between VA and RA, RA-TMIE can be a promising surgical procedure for esophageal cancer patients.