Early outcomes with robot-assisted vs. minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of matched studies

OBJECTIVE: The current study aimed to compare intraoperative and early postoperative outcomes with robot-assisted esophagectomy (RAE) vs. minimally invasive esophagectomy (MIE) for esophageal cancer. MATERIALS AND METHODS: We searched PubMed, Embase, and Google Scholar for randomized controlled trials (RCTs) or propensity-matched cohort studies comparing RAE with MIE for patients with esophageal cancer. RESULTS: One RCT and 14 retrospective propensity-matched studies were included. Meta-analysis revealed significantly increased operative time (MD: 32.89 95% CI: 6.42, 59.35 I-2 =95% p=0.01) and reduced blood loss (MD: -35.15 95% CI: -61.30, -8.99 I-2 =82% p=0.008) with RAE. Both the results turned statistically non-significant on exclusion of one study. The was no difference between the two techniques for anastomotic leak (RR: 0.98 95% CI: 0.76, 1.24 I-2 =0% p=0.84), chyle leak (RR: 0.94 95% CI: 0.48, 1.83 I-2 =0% p=0.86), recurrent laryngeal nerve palsy (RR: 0.92 95% CI: 0.61, 1.391 2 =70% p=0.69), cardiac complication (RR: 1.06 95% CI: 0.64, 1.78 I-2 =0% p=0.82), infectious complications (RR: 1.06 95% CI: 0.47, 2.42 I-2 =0% p=0.88), conversion to open surgery (RR: 0.60 95% CI: 0.25, 1.43 I-2 =56% p=0.25) or early mortality (RR: 1.04 95% CI: 0.74, 1.47 I-2 =0% p=0.82). However, pulmonary complications were significantly reduced with RAE as compared to MIE (RR: 0.72 95% CI: 0.60, 0.86 I-2 =0% p=0.003). CONCLUSIONS: RAE is associated with a tendency of longer operating time and reduced blood loss as compared to MIE. RAE significantly reduces pulmonary complications as compared to MIE but has no impact on the incidence of anastomotic leak, chyle leak, RLN palsy, cardiac complication, infectious complications, conversion to open surgery, or early mortality.