PD02.08. Robot-Assisted Extended Free Jejunum Interposition Versus McKeown Esophagectomy in Thoracic Esophageal Cancer: A Comparative Study of Perioperative and Quality-of-Life Outcomes

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Gastrointestinal complications related to gastric conduit reconstruction adversely affect quality of life (QoL) in patients undergoing esophagectomy for esophageal cancer (EC). We introduced a robot-assisted extended free jejunal interposition (EFJI) technique for intrathoracic esophageal cancer that preserves gastric and cardiac function (Figure 1A). This study aimed to compare perioperative outcomes and QoL between robot-assisted EFJI and McKeown esophagectomy in patients with upper thoracic esophageal cancer. From February 2025 to August 2025, patients with upper thoracic esophageal cancer scheduled for robot-assisted EFJI or McKeown esophagectomy at our center were enrolled. Contrast-enhanced computed tomography confirmed the absence of metastasis to middle/lower mediastinal lymph nodes, abdominal lymph nodes, and distant organs. Surgical outcomes, complications, QoL, and oncologic survival were compared between the two groups. Ten patients underwent EFJI and 49 underwent McKeown esophagectomy. The EFJI group had longer operative time and greater intraoperative blood loss. However, complication rates (30.0% vs. 32.7%, Figure 1B) and length of hospital stay (10 vs. 9 days) were comparable between groups. Pain scores were significantly lower in the EFJI group at postoperative day 30 (2.2 vs. 13.3, p=0.032) and day 90 (2.2 vs. 11.1, p=0.031). Reflux scores were similar at day 30 (6.7 vs. 21.7) but significantly lower in the EFJI group at day 90 (5.0 vs. 32.5, p=0.011). Additionally, EFJI patients demonstrated lower symptom burden on the EORTC QLQ-OES18 at both 30 and 90 days postoperatively (Figure 1C), although no significant difference was observed in global QoL scores on the EORTC QLQ-C30 (Figure 1D). With a median follow-up of 6.8 months, one patient in each group developed local recurrence or distant metastasis, and recurrence-free survival rates were comparable. Robot-assisted EFJI represents a safe reconstruction alternative following segmental resection of upper thoracic esophageal cancer and is associated with significantly reduced postoperative reflux compared with traditional McKeown esophagectomy.