P1.226. Short- and Mid-Term Outcomes of Robot-Assisted Minimally Invasive Esophagectomy: Experience With 80 Cases

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes The number of robot-assisted minimally invasive esophagectomy (RAMIE) performed in Japan is increasing due to its potential advantages. We introduced RAMIE in 2019 and have standardized the technique, including linear-stapled intra-thoracic anastomosis. We retrospectively evaluated short- and mid-term outcomes in 80 patients who underwent RAMIE for esophageal or EGJ cancer between August 2019 and December 2025. Factors included patient backgrounds, details of surgical procedures, postoperative complications, length of hospital stay, body-weight loss, symptom subscale and total symptom score by PGSAS-37, overall survivals. The surgical procedure involved initial mobilization of the esophagus, followed by total mediastinal dissection. Left cervical-thoracic region was dissected after esophageal resection. The procedure was standardized, focusing on sharp dissection using monopolar scissors. A dry surgical field was maintained by pre-coagulating small vessels with Maryland forceps and using a vessel sealer as needed. The learning curve of a surgeon who introduced RAMIE was also evaluated using CUSUM analysis. Median patient age was 72 years. Clinical stage distribution was 0/I/II/III/IV: 3/19/14/42/2. Primary tumor sites were Ce/Ut/Mt/Lt/Jz: 2/14/34/20/10. Surgical procedures included McKeown/Ivor Lewis: 27/53. Median thoracic console time was 192 minutes for lymph node dissection and 78 minutes for intrathoracic anastomosis. CUSUM analysis indicated that initial proficiency was achieved after 11 cases, with console dissection time shortened to 146 minutes. Median blood loss was 50 ml. Major postoperative complications included anastomotic leakage (11%), recurrent laryngeal nerve palsy (11%), and pneumonia (10%). Grade≥IIIb complications occurred in 5 cases (6.3%). The median hospital stay was 16.5 days. The 90-day mortality was 1.2%. The mean body-weight loss at 12 months after RAMIE was 10.02%. The mean total symptom score by PGSAS-37 was 1.95. The 3-year overall survival rate was 66.4%. The short- and mid-term outcomes of RAMIE were favorable. The next challenge is to confirm long-term outcomes while leveraging the robot's short learning curve to safely and efficiently train junior surgeons.