Comparative outcomes of robot-assisted minimally invasive versus open esophagectomy in patients with esophageal squamous cell carcinoma: a propensity score-weighted analysis

Robots are increasingly used in minimally invasive surgery. We evaluated the clinical benefits of robot-assisted minimally invasive esophagectomy (RAMIE) in comparison with the conventional open esophageal surgery. From 2012 to 2016, 371 patients with esophageal squamous cell carcinoma underwent an Ivor Lewis or McKeown procedure at our institution. Of these, 130 patients underwent laparoscopic gastric conduit formation followed by RAMIE, whereas 241 patients underwent conventional esophageal surgery, including laparotomy and open esophagectomy (OE). We compared the short- and long-term clinical outcomes of these patients using the propensity score-based inverse probability of treatment weighting technique (IPTW). Among the early outcomes, the OE group showed a higher incidence of pneumonia (P=0.035) and a higher requirement for vasopressors (P=0.001). Regarding the long-term outcomes, all-cause mortality was significantly higher (P=0.001) and disease-free survival was lower (P=0.006) in the OE group. Wound-related problems also occurred more frequently in the OE group (P=0.020) during the long-term follow-up. There was no statistical intergroup difference in the recurrence rates (P=0.191). The Cox proportional-hazard analysis demonstrated that wound problems (HR 0.16, 95% CI 0.02-0.57; P=0.017), pneumonia (HR 0.23, 95% CI 0.06-0.68; P=0.019), and use of vasopressors (HR 0.14, 95% CI 0.08-0.25; P=0.001) were independent predictors of mortality. RAMIE could be a better surgical option for selected patients with esophageal squamous cell carcinoma.