Long-term oncologic outcomes of robot-assisted versus conventional open esophagectomy for esophageal cancer: Propensity-score matched anaylsis.

Background: This study aimed to compare the long-term oncologic outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) with those of conventional open esophagectomy (OE) for esophageal cancer.

Methods: Between January 2006 and December 2021, 1745 consecutive patients underwent esophagectomy for esophageal cancer at Asan Medical Center, Korea. Among them, we retrieved 1133 patients (mean age 63.1 ± 7.8 years, 86 [7.6 %] women, 1100 [97.1 %] squamous cell carcinomas), who were operated by a single surgeon. These patients were categorized into following two groups based on their surgical approaches: RAMIE (n = 497) and OE (n = 636). The RAMIE and OE groups were matched in a 1:1 ratio using propensity scores. Overall survival (OS) and recurrence-free survival (RFS) were compared between the groups.

Results: The median follow-up was 51.8 (24.6-90.2, interquartile) months. Five-year OS (70.7 % vs. 55.0 %, P < 0.01) and RFS (63.3 % vs. 50.1 %, P < 0.01) rates were significantly higher in RAMIE than in OE group. Following propensity-score matching, 886 patients (443 pairs) were successfully matched, demonstrating no significant intergroup differences, including the pathologic stage. The RAMIE group consistently demonstrated enhanced OS (70.4 % vs. 61.8 %, P < 0.01) and RFS (62.8 % vs. 55.8 %, P = 0.04) after five years, even after adjustment. The rate of noncancer mortality was significantly higher in the OE group (P < 0.01), whereas the rate of esophageal cancer-related mortality showed no significant differences between the groups (P = 0.25).

Conclusions: RAMIE could be a safer option for patients compared with conventional open esophagectomy with favorable long-term outcomes related to noncancer mortality.