Enhanced short-term outcomes after full robotic-assisted minimally invasive Ivor Lewis procedure compared to the hybrid approach

Since its introduction in the early 2000s, full robotic-assisted esophagectomy has remained a niche technique due to debated short-term outcomes. While some studies have reported improved postoperative outcomes with fully minimally invasive approaches compared to open or hybrid esophagectomy, the high rate of postoperative anastomotic leaks stands as a significant limitation. This study evaluates the short-term outcomes of robotic-assisted esophagectomy. We prospectively collected data on patients undergoing robotic-assisted Ivor Lewis esophagectomy for esophageal cancer at our center from January 2017 to October 2024. All patients underwent a robotic abdominal approach and were divided into two groups based on the thoracic approach: open thoracotomy (Hybrid-RAMIE) or robotic thoracoscopy (Full-RAMIE). We compared patients’ characteristics and short-term postoperative outcomes. A total of 59 consecutive patients were included (27 in the Hybrid-RAMIE and 32 in the Full-RAMIE). Patients’ characteristics were comparable. Both groups showed similar rates of severe morbidity (CD ≥ 3) although the rate of life-threatening complications (CD ≥ 4) was significantly lower in the Full-RAMIE group. The Hybrid-RAMIE group exhibited a significantly higher rate of grade IV complications (22.2%) compared to the Full-RAMIE group (0%, p = 0.005), primarily due to severe pulmonary infections. In the Full-RAMIE group, the majority of complications were grade IIIb, predominantly anastomotic leaks (29%). Most were managed non-operatively, and this rate declined significantly after the learning curve. Our findings indicates that Full-RAMIE is associated with better postoperative outcomes, including a lower risk of severe pulmonary infections. The anastomotic leak rate for Full-RAMIE significantly declined to 6% after the learning curve was surpassed.