Short- and Long-term Outcomes of Robotic versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer: A Multicenter Propensity Score-matched Cohort Study

Background: Although robot-assisted minimally invasive esophagectomy (RAMIE) reportedly provides better short-term and comparable long-term outcomes compared with open esophagectomy, its long-term outcomes versus those of minimally invasive esophagectomy (MIE) remain insufficiently investigated. This multicenter retrospective cohort study aimed to investigate the perioperative safety, efficacy, and long-term survival of patients of RAMIE versus MIE for esophageal cancer. Methods: We included patients with cStage 0-IVa thoracic esophageal cancer who underwent esophagectomy through the right thoracic cavity between January 2016 and December 2019 in six Japanese hospitals. The short- and long-term outcomes between RAMIE and MIE were compared by using propensity score matching. Results: After matching, 268 of 396 patients were analyzed. Compared with MIE, RAMIE had a longer operative time (629 vs. 574 min, p < 0.01), a trend toward less severe morbidity (Clavien–Dindo grade ≥ III: 18% vs. 23%), and a lower incidence (22% vs. 34%, p = 0.02) and mitigated severity of recurrent laryngeal nerve (RLN) palsy (p = 0.040). Blood loss, inhospital mortality, and the mediastinal node harvest were similar between the two techniques. The 3- and 5-year overall survival rates were 77% and 66% for RAMIE and 74% and 66% for MIE (hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.57–1.37; p = 0.59). Relapse-free survival was also similar (3-year 64% vs. 63%; 5-year 61% vs. 59%; HR 0.87; 95% CI 0.60–1.28; p = 0.49). Conclusions: RAMIE reduced the incidence and severity of RLN palsy despite requiring a longer operation time and demonstrated similar long-term outcomes to MIE.