Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy: A propensity score-matched study via a nationwide database

Tatsuto Nishigori, Hiraku Kumamaru, Kazutaka Obama, Koichi Suda, Shigeru Tsunoda, Yukie Yoda, Makoto Hikage, Susumu Shibasaki, Tsuyoshi Tanaka, Masanori Terashima, Yoshihiro Kakeji, Masafumi Inomata, Yuko Kitagawa, Hiroaki Miyata, Yoshiharu Sakai, Hirokazu Noshiro, Ichiro Uyama

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The advantages of robot-assisted minimally invasive esophagectomy (RA-MIE) over conventional minimally invasive esophagectomy (C-MIE) are unknown. This nationwide large-scale study aimed to compare surgical outcomes between RA-MIE and C-MIE using rigorous propensity score methods, including detailed covariates and relevant outcomes. Methods: This Japanese nationwide retrospective cohort study included RA-MIE or C-MIE for esophageal malignant tumors performed between October 2018 and December 2019 and registered in the Japanese National Clinical Database. The primary outcome measure was postoperative complications classified as Clavien–Dindo Grade IIIa or higher. Propensity score matching was performed to create a balanced covariate distribution between the two groups. Results: After propensity score matching, 1092 patients were selected. The RA-MIE group had a significantly longer operation time and greater blood loss than the C-MIE group (565 vs. 477 min and 120 vs. 90 mL). Furthermore, the R0 resection rate was lower in the RA-MIE group than in the C-MIE group (95.1% vs. 97.8%). The RA-MIE and C-MIE groups had no differences regarding overall complications ≥ Grade IIIa (22.0% vs. 20.3%, p = 0.52), 30-day mortality rates (0.4% vs. 0.5%), and operative mortality rates (0.7% vs. 0.7%). Deep SSI was less frequent (2.7% vs. 6.0%) and pulmonary embolism was more frequent (2.4% vs. 0.5%) in the RA-MIE group than in the C-MIE group. Conclusions: In the initial phase of implementation, RA-MIE and C-MIE demonstrated comparable morbidity rates when performed by skilled board-certified endoscopic surgeons.

Original languageEnglish
Pages (from-to)109-118
Number of pages10
JournalAnnals of Gastroenterological Surgery
Volume9
Issue number1
DOIs
Publication statusPublished - 01-2025

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

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