Oncologic outcomes in patients undergoing robotic esophagectomy.

Abstract

328 Background: Esophageal cancer (EC) is associated with significant mortality worldwide. Robotic assisted minimally invasive esophagectomy (RAMIE) has been established to potentially decrease morbidity while potentially improving oncologic outcomes compared to other approaches. We sought to evaluate oncologic outcomes associated with a single surgeon’s experience in this largest series of RAMIE. Methods: Utilizing a prospectively maintained esophageal database, we identified patients who were diagnosed with EC and underwent RAMIE between 2010-2025. Baseline univariate comparisons were made for continuous variables using Mann-Whitney U and Pearson’s Chi-square test for categorical variables. Results: We identified 365 patients who underwent RAMIE with a median age of 69 (30-91). There were 291 (79.7%) males and 74 (20.3%) females. The mean BMI was 27 ± 6.3 and mean ASA score was 2.9 ± 0.6. Adenocarcinoma was the predominate histology at 302 (82.7%) while squamous cell carcinoma represented only 13.2% of patients. Locally advanced T3/T4 tumors were identified in 212 (58.1%) patients and 180 (49.3%) had clinical node + disease. Neoadjuvant therapy was utilized in 292 (80%) patients. The median, length of operation was 331 (275 – 401) minutes, estimated blood loss 100 (50 – 150) milliliters, lymph nodes resected 18 (14 – 23), and length of hospitalization 9 (7 – 11) days. R0 resections was performed in 362 (99.2%) of patients and the pathologic complete response rates were 36.4%. Post-operative complications occurred in 112 (30.7%) patients. The 30 and 90-day mortality were 9 (2.5%) and 17 (4.7%) respectively. The median and overall 5-year survival was 58.2 months and 48%. Conclusions: Robotic assisted minimally invasive esophagectomy continues to demonstrate exemplary outcomes. The R0 resection rates, lymph node harvest and overall survival continue to rival other approaches. Our data continue to support this approach as the standard for surgeons performing esophageal resections for malignancy.