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<p>Robot-assisted minimally invasive esophagectomy (RAMIE) using the da Vinci system has emerged as a promising alternative to conventional approaches for treating resectable esophageal cancer. However, high-quality evidence comparing RAMIE and conventional esophagectomy remains limited.&#xa0;This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420251158840). We systematically searched multiple databases, MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, the Web of Science Core Collection, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to September 2025 for randomized controlled trials comparing da Vinci robot-assisted esophagectomy with conventional approaches (minimally invasive or open esophagectomy) in adults with resectable esophageal cancer. The primary outcomes included anastomotic leak, pneumonia, R0 resection, and 90-day mortality. Secondary outcomes included operative metrics, hospital stay, and complications. Random-effects meta-analyses were performed using risk ratios for dichotomous outcomes and mean differences for continuous outcomes. Evidence certainty was assessed using the GRADE methodology.&#xa0;Three randomized controlled trials including 549 patients (284 RAMIE, 265 conventional) were analyzed. RAMIE demonstrated statistically significant but clinically modest reduction in intraoperative blood loss (mean difference − 68.34 mL, 95% CI − 134.48 to − 2.20, <i>P</i> = 0.04; low certainty). No significant differences were observed in anastomotic leak (RR 1.24, 95% CI 0.83–1.86; low certainty), pneumonia (RR 0.71, 95% CI 0.47–1.06; low certainty), R0 resection (RR 0.99, 95% CI 0.94–1.04; moderate certainty), 90-day mortality (RR 1.66, 95% CI 0.34–8.11; very low certainty), hospital length of stay (MD − 3.26 days, 95% CI − 8.33 to 1.82; very low certainty), or ICU length of stay (MD − 0.10 days, 95% CI − 0.39 to 0.20; moderate certainty). Recurrent laryngeal nerve palsy showed no significant difference (RR 0.87, 95% CI 0.51–1.48; very low certainty) with substantial heterogeneity (I²=66%) due to variable assessment methods and timing. GRADE certainty ranged from very low to moderate across outcomes, predominantly limited by imprecision and inconsistency. Importantly, no trials evaluated robot-assisted anastomotic reconstruction, limiting assessment of robotic surgery’s full potential.&#xa0;Robot-assisted esophagectomy demonstrated comparable short-term safety and oncological adequacy to conventional approaches, with statistically but not clinically significant reduction in blood loss (− 68 mL). Current evidence supports RAMIE as viable but does not assess potential benefits in robot-assisted intrathoracic anastomoses, lymphadenectomy quality, or functional recovery. Future trials addressing these gaps are needed.</p>

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Robot-assisted (da Vinci) versus conventional esophagectomy for resectable esophageal cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Wajahat Mirza,
  • Mehak Ejaz Khan,
  • Hania Iqbal,
  • Alishbah Khan,
  • Hadi Mohammad Khan,
  • Hamza Nasir Chatha,
  • Sundus Dadan

摘要

Robot-assisted minimally invasive esophagectomy (RAMIE) using the da Vinci system has emerged as a promising alternative to conventional approaches for treating resectable esophageal cancer. However, high-quality evidence comparing RAMIE and conventional esophagectomy remains limited. This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420251158840). We systematically searched multiple databases, MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, the Web of Science Core Collection, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to September 2025 for randomized controlled trials comparing da Vinci robot-assisted esophagectomy with conventional approaches (minimally invasive or open esophagectomy) in adults with resectable esophageal cancer. The primary outcomes included anastomotic leak, pneumonia, R0 resection, and 90-day mortality. Secondary outcomes included operative metrics, hospital stay, and complications. Random-effects meta-analyses were performed using risk ratios for dichotomous outcomes and mean differences for continuous outcomes. Evidence certainty was assessed using the GRADE methodology. Three randomized controlled trials including 549 patients (284 RAMIE, 265 conventional) were analyzed. RAMIE demonstrated statistically significant but clinically modest reduction in intraoperative blood loss (mean difference − 68.34 mL, 95% CI − 134.48 to − 2.20, P = 0.04; low certainty). No significant differences were observed in anastomotic leak (RR 1.24, 95% CI 0.83–1.86; low certainty), pneumonia (RR 0.71, 95% CI 0.47–1.06; low certainty), R0 resection (RR 0.99, 95% CI 0.94–1.04; moderate certainty), 90-day mortality (RR 1.66, 95% CI 0.34–8.11; very low certainty), hospital length of stay (MD − 3.26 days, 95% CI − 8.33 to 1.82; very low certainty), or ICU length of stay (MD − 0.10 days, 95% CI − 0.39 to 0.20; moderate certainty). Recurrent laryngeal nerve palsy showed no significant difference (RR 0.87, 95% CI 0.51–1.48; very low certainty) with substantial heterogeneity (I²=66%) due to variable assessment methods and timing. GRADE certainty ranged from very low to moderate across outcomes, predominantly limited by imprecision and inconsistency. Importantly, no trials evaluated robot-assisted anastomotic reconstruction, limiting assessment of robotic surgery’s full potential. Robot-assisted esophagectomy demonstrated comparable short-term safety and oncological adequacy to conventional approaches, with statistically but not clinically significant reduction in blood loss (− 68 mL). Current evidence supports RAMIE as viable but does not assess potential benefits in robot-assisted intrathoracic anastomoses, lymphadenectomy quality, or functional recovery. Future trials addressing these gaps are needed.