Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy: A propensity score-matched study via a nationwide database.

BACKGROUND

The advantages of robot-assisted minimally invasive esophagectomy (RA-MIE) over conventional minimally invasive esophagectomy (C-MIE) are unknown. This nationwide large-scale study aimed to compare surgical outcomes between RA-MIE and C-MIE using rigorous propensity score methods, including detailed covariates and relevant outcomes.

METHODS

This Japanese nationwide retrospective cohort study included RA-MIE or C-MIE for esophageal malignant tumors performed between October 2018 and December 2019 and registered in the Japanese National Clinical Database. The primary outcome measure was postoperative complications classified as Clavien-Dindo Grade IIIa or higher. Propensity score matching was performed to create a balanced covariate distribution between the two groups.

RESULTS

After propensity score matching, 1092 patients were selected. The RA-MIE group had a significantly longer operation time and greater blood loss than the C-MIE group (565 vs. 477 min and 120 vs. 90 mL). Furthermore, the R0 resection rate was lower in the RA-MIE group than in the C-MIE group (95.1% vs. 97.8%). The RA-MIE and C-MIE groups had no differences regarding overall complications ≥ Grade IIIa (22.0% vs. 20.3%,  = 0.52), 30-day mortality rates (0.4% vs. 0.5%), and operative mortality rates (0.7% vs. 0.7%). Deep SSI was less frequent (2.7% vs. 6.0%) and pulmonary embolism was more frequent (2.4% vs. 0.5%) in the RA-MIE group than in the C-MIE group.

CONCLUSIONS

In the initial phase of implementation, RA-MIE and C-MIE demonstrated comparable morbidity rates when performed by skilled board-certified endoscopic surgeons.