P1.161. Textbook Outcome Following Esophagectomy in the Era of Robotic Surgery

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Textbook outcome (TO) is a composite quality metric reflecting optimal perioperative care following esophagectomy. With increasing adoption of minimally invasive and robotic techniques, variation in achieving TO across surgical approaches remains uncertain. This study compared TO attainment following open, hybrid, and robotic-assisted minimally invasive esophagectomy. All patients undergoing esophagectomy between October 2019 and May 2025 for cancer were retrospectively analysed at a single high-volume centre. Surgical approaches were categorised as open, hybrid (robotic-assisted abdominal phase / open chest phase) or robotic-assisted minimally invasive esophagectomy (RAMIE). Operations with other approaches like laparoscopic or thoracoscopic were excluded. TO was defined according to the recently updated international Delphi consensus on esophageal cancer surgery from 2021, incorporating tumour-negative margins, adequate lymphadenectomy (≥20 nodes), absence of intraoperative and major postoperative complications (Clavien–Dindo ≥III), no anastomotic leakage, no ICU/MCU readmission, no prolonged hospital stay (≥14 days), no in-hospital mortality, and no surgical readmission. TO attainment and individual components were compared across surgical approaches using chi-square testing, with p<0.05 considered statistically significant. A total of 282 patients were analysed (open n=156; hybrid n=50; RAMIE n=76). Overall, TO was achieved in 51.3% open, 52.0% hybrid, and 43.4% RAMIE (p=0.52). R0 resection rates were 94.9%, 100%, and 96.1% (p=0.45), and adequate lymph node harvest (≥20 nodes) occurred in 95.5%, 96.0%, and 96.1% (p=0.37). No intraoperative complications occurred in 97.4%, 100%, and 97.4% (p=0.52). Absence of major complications (Clavien–Dindo ≥III) was 68.6%, 64.0%, and 55.3% (p=0.14). No anastomotic leak occurred in 80.1%, 94.0%, and 78.9% (p=0.06). No ICU/MCU readmission rates were 82.1%, 76.0%, and 85.5% (p=0.40), hospital stay <14 days in 66.0%, 76.0%, and 80.3% (p=0.06), no in-hospital mortality 96.8%, 98.0%, 97.4% (p=0.90), and no surgical readmission 85.3%, 84.0%, and 77.6% (p=0.34). Approximately half of patients achieved TO following esophagectomy. Open and hybrid approaches showed comparable TO attainment, while RAMIE had lower rates, though differences were not statistically significant. These findings highlight opportunities for optimisation during robotic esophagectomy adoption and support the use of textbook outcome as a benchmark for perioperative quality assessment.