Short-term outcomes of robot-assisted transcervical esophagectomy for thoracic esophageal carcinoma.

BACKGROUND

Minimally invasive robot-assisted transcervical esophagectomy (TCE) has emerged as a novel technique for thoracic esophagectomy in patients with thoracic esophageal carcinoma, with sporadic reports highlighting its feasibility. However, its short-term surgical outcomes and safety profile in a well-defined series with a substantial number of cases remain unclear. This study aims to address this knowledge gap by systematically evaluating the feasibility and safety of this approach.

METHODS

Fifty patients undergoing robot-assisted TCE between 2023 and 2024 were included. At our institution, robot-assisted TCE is reserved for patients with previous thoracic surgery, poor performance status, or other conditions contraindicating thoracic approaches. This procedure employed bilateral cervical approaches with continuous nerve-integrated monitoring in all cases. Robot-assisted TCE was performed using the da Vinci Xi system, with dissection and lymphadenectomy of the thoracic esophageal regions, including the bilateral recurrent laryngeal nerve lymph nodes.

RESULTS

All patients successfully underwent robot-assisted TCE with no intraoperative adverse events. The mean patient age was 73.8 years, and the male-to-female ratio was 43:7. Clinical staging was I/II/III/IV: 19/6/20/5, with 58% of patients receiving neoadjuvant chemotherapy. More than 80% had significant systemic or pulmonary comorbidities. All robot-assisted TCE procedures, including bilateral cervical dissection, were performed without intraoperative complications. Postoperative complications included recurrent laryngeal nerve paralysis (12.0%, Clavien-Dindo Grade ≥ 1) and pneumonia (6.0%, Grade ≥ 2).

CONCLUSIONS

Robot-assisted TCE is a relatively safe and feasible technique. The transhiatal robotic approach allows for precise mediastinal lymphadenectomy. Short-term outcomes suggest acceptable rates of recurrent laryngeal nerve paralysis and pulmonary complications. Further research will focus on improving reproducibility in challenging cases and evaluating mid-term outcomes.