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Background <p>This study compared surgical outcomes among robot-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant therapy (NAT).</p> Patients and Methods <p>After 1:1:1 propensity score matching (PSM) of 667 eligible patients (<i>n</i> = 56 per group), we compared lymph node (LN) yield, postoperative outcomes, survival, and subgroup analysis by tumor location.</p> Results <p>After PSM, RAMIE achieved higher total LN yield than MIE (45.4 versus 36.3, <i>P</i> = 0.003) and OE (30.1, <i>P</i> &lt; 0.001), particularly in the upper mediastinum (2R/2L/4L and 8U), subcarinal (7), cervical (1R), and perigastric stations (all <i>P</i> &lt; 0.05). Recurrent laryngeal nerve (RLN) palsy was lower with RAMIE versus MIE (8.9% versus 26.8%, <i>P</i> = 0.041) and OE (28.6%, <i>P</i> = 0.023). Hospital stay was shorter for RAMIE versus MIE (9 versus 12 days, <i>P</i> = 0.001) and OE (15 days, <i>P</i> &lt; 0.001). Most postoperative outcomes showed no intergroup differences. Both RAMIE and MIE were associated with better overall survival (OS) and disease-free survival (DFS) versus OE (hazard ratio [HR] 0.39–0.46; <i>P</i> &lt; 0.05), with no significant difference between them. Exploratory analyses suggested that this association was more apparent for upper/middle tumors.</p> Conclusions <p>For NAT-treated resectable ESCC, RAMIE offers more extensive lymphadenectomy extent (higher LN yield) and safety (lower RLN palsy, shorter hospitalization) over MIE/OE. Both minimally invasive techniques showed better survival than OE and support their use after NAT, with a relatively stronger signal for upper/middle tumors.</p>

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Surgical Outcomes of Robotic, Minimally Invasive, and Open Esophagectomy After Neoadjuvant Therapy: a Propensity Score-Matching Study

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Jiahuang Hong,
  • Peiyuan Wang,
  • Junpeng Lin,
  • Hao He,
  • Huaiyuan Zhang,
  • Youqiang Qiu,
  • Xiaoyong Liu,
  • Shuoyan Liu,
  • Feng Wang

摘要

Background

This study compared surgical outcomes among robot-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant therapy (NAT).

Patients and Methods

After 1:1:1 propensity score matching (PSM) of 667 eligible patients (n = 56 per group), we compared lymph node (LN) yield, postoperative outcomes, survival, and subgroup analysis by tumor location.

Results

After PSM, RAMIE achieved higher total LN yield than MIE (45.4 versus 36.3, P = 0.003) and OE (30.1, P < 0.001), particularly in the upper mediastinum (2R/2L/4L and 8U), subcarinal (7), cervical (1R), and perigastric stations (all P < 0.05). Recurrent laryngeal nerve (RLN) palsy was lower with RAMIE versus MIE (8.9% versus 26.8%, P = 0.041) and OE (28.6%, P = 0.023). Hospital stay was shorter for RAMIE versus MIE (9 versus 12 days, P = 0.001) and OE (15 days, P < 0.001). Most postoperative outcomes showed no intergroup differences. Both RAMIE and MIE were associated with better overall survival (OS) and disease-free survival (DFS) versus OE (hazard ratio [HR] 0.39–0.46; P < 0.05), with no significant difference between them. Exploratory analyses suggested that this association was more apparent for upper/middle tumors.

Conclusions

For NAT-treated resectable ESCC, RAMIE offers more extensive lymphadenectomy extent (higher LN yield) and safety (lower RLN palsy, shorter hospitalization) over MIE/OE. Both minimally invasive techniques showed better survival than OE and support their use after NAT, with a relatively stronger signal for upper/middle tumors.