Analysis of perioperative outcomes for esophageal cancer: comparison of  robotic-assisted and video-assisted minimally invasive esophagectomy

Objective: Comparing the perioperative outcomes of single-thorax robotic-assisted McKeown minimally invasive esophagectomy (RAMIE) and video-assisted McKeown minimally invasive esophagectomy (VAMIE) in a balanced population. Methods From June 2017 to May 2022, 193 esophageal cancer patients were retrospectively included, including 75 cases receiving RAMIE and 118 receiving VAMIE. The balanced population was generated by propensity-score matching, and statistical analyses were conducted to compare patients' demographics and perioperative outcomes in these two groups. Results A total of 57 RAMIE cases were matched with 57 VAMIE cases by propensity score. Although the total cost of the RAMIE group after matching was higher than that of the VAMIE group (118.28k vs 136.79k, P = 0.027), there were no significant differences in the number of chest LNs, postoperative drainage and postoperative cardiopulmonary complications. When compared to the VAMIE group, the RAMIE group after matching had shorter surgery time (total 335.00 vs. 235.00 min, P < 0.001; chest 244.00 vs. 139.00 min, P < 0.001), less intraoperative blood loss (200.00 vs. 100.00 ml, P < 0.001), less intraoperative rehydration (2400.00 vs. 1500.00 ml, P < 0.001), lower postoperative VAS (P < 0.001), fewer postoperative hospitalization days (20.00 vs. 14.00 days, P < 0.001), and lower incidence of anastomotic leak (8 [14.04%] vs. 2 [3.51%], P = 0.047). Conclusion Compared with VAMIE, the single-thorax RAMIE has shorter surgery time, less intraoperative blood loss/rehydration, less postoperative pain, and a lower incidence of anastomotic leak.