P1.186. Clinical Utility of Robot-Assisted Esophagectomy Based on Short- and Long-Term Outcomes

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Our department introduced thoracoscopic esophagectomy in the left lateral–prone hybrid position (MIE) in 2017 and robot-assisted thoracoscopic esophagectomy (RAMIE) in the semi-prone position using the da Vinci Xi system in 2018 and hinotori system in 2023. Both procedures have been performed concurrently under a shared conceptual framework emphasizing lymphadenectomy along the optimal dissection planes based on precise membranous anatomy. This study aimed to compare the short- and long-term outcomes of RAMIE with those of MIE and to evaluate the clinical utility of RAMIE. We retrospectively reviewed consecutive patients who underwent esophagectomy with gastric conduit reconstruction and cervical anastomosis for thoracic esophageal cancer or esophagogastric junction cancer between July 2018 and June 2025. Salvage surgery, staged reconstruction, and pharyngolaryngoesophagectomy cases were excluded. A total of 123 patients who underwent MIE and 150 who underwent RAMIE were analyzed. Clinicopathological factors and short- and long-term outcomes were compared between the two groups. There were no significant differences in preoperative patient characteristics, including age, sex, BMI, PNI, and NLR. However, preoperative pulmonary function (FEV1.0%) was slightly lower in the RAMIE group (75.4% vs. 73.3%, P = 0.026). Adenocarcinoma was more frequent in the RAMIE group (17.9% vs. 30.7%, P = 0.045). There were no differences in laparoscopic abdominal procedures, thoracic duct resection, extent of lymphadenectomy, or reconstruction route. Postoperative supraventricular arrhythmia was significantly less frequent in the RAMIE group (8.1% vs. 0.7%, P = 0.002) while othre complications were comparable between groups, including recurrent laryngeal nerve palsy (8.9% vs. 5.3%), pneumonia (12.2% vs. 9.3%), atelectasis (9.8% vs. 5.3%), anastomotic leakage (11.4% vs. 14.0%), and surgical site infection (1.6% vs. 4.0%) . There was no surgery-related mortality in either group. Recurrence-free survival (P = 0.819) and overall survival (P = 0.802) did not differ significantly between the two groups. RAMIE can be safely performed for thoracic esophageal cancer and esophagogastric junction cancer, contributing to the reduction of postoperative complications without compromising curative outcomes.