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Background <p>Although the efficacy of robot-assisted minimally invasive esophagectomy (RAMIE) in locally advanced esophageal cancer has been suggested, solid evidence is lacking. In this study, we examined the short- and middle-term outcomes of RAMIE in patients with highly locally advanced esophageal cancer who were initially diagnosed with cT3 borderline resectable or cT4b (cT3br/cT4b) disease and deemed resectable after preoperative treatment. Furthermore, we compared the short- and middle-term outcomes of RAMIE with conventional minimally invasive esophagectomy (cMIE).</p> Methods <p>Eighty-one patients with locally advanced initial T3br and T4 esophageal squamous cell carcinoma previously treated with chemotherapy or chemoradiation underwent minimally invasive esophagectomy with curative intent between 2018 and 2022. We then examined the short- and long-term outcomes of RAMIE compared with cMIE in patients initially diagnosed with stage cT3br/cT4b disease.</p> Results <p>Among these 81 patients, 33 underwent RAMIE and 48 underwent cMIE. The average age of the 81 patients was 65.8&#xa0;years, with tumors located primarily in the mid-esophagus (55.6%). Most patients initially had stage cT3br (56.8%) or cT4b (43.2%) disease, with 88.9% showing invasion near the trachea or bronchus. No significant differences were observed between the cMIE and RAMIE groups for operation time, blood loss, or common postoperative complications. However, the RAMIE group had a lower incomplete resection rate vs the cMIE group (9.0% vs 16.6%, respectively). The 3-year overall survival rate was 63.1%, with RAMIE showing slightly better survival rates compared with cMIE (p = 0.032). The prognostic factors in the RAMIE group indicated better outcomes for single-organ vs multiple-organ invasion (p = 0.036) and patients with a higher histological response (p = 0.048).</p> Conclusion <p>RAMIE may offer improved outcomes for highly locally advanced esophageal cancer, such as patients with stage T3br or T4b disease. Future studies that analyze data for high numbers of cases in multiple facilities are needed.</p>

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Short-and middle-term outcomes of robot-assisted minimally invasive esophagectomy for highly locally advanced esophageal cancer with stage cT3 borderline and cT4b at initial diagnosis

  • 期刊论文

  • 发表日期：

    2025年3月21日

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  • Takeo Fujita,
  • Kazuma Sato,
  • Daisuke Kajiyama,
  • Yuto Kubo,
  • Naoto Fujiwara,
  • Hiroyuki Daiko

摘要

Background

Although the efficacy of robot-assisted minimally invasive esophagectomy (RAMIE) in locally advanced esophageal cancer has been suggested, solid evidence is lacking. In this study, we examined the short- and middle-term outcomes of RAMIE in patients with highly locally advanced esophageal cancer who were initially diagnosed with cT3 borderline resectable or cT4b (cT3br/cT4b) disease and deemed resectable after preoperative treatment. Furthermore, we compared the short- and middle-term outcomes of RAMIE with conventional minimally invasive esophagectomy (cMIE).

Methods

Eighty-one patients with locally advanced initial T3br and T4 esophageal squamous cell carcinoma previously treated with chemotherapy or chemoradiation underwent minimally invasive esophagectomy with curative intent between 2018 and 2022. We then examined the short- and long-term outcomes of RAMIE compared with cMIE in patients initially diagnosed with stage cT3br/cT4b disease.

Results

Among these 81 patients, 33 underwent RAMIE and 48 underwent cMIE. The average age of the 81 patients was 65.8 years, with tumors located primarily in the mid-esophagus (55.6%). Most patients initially had stage cT3br (56.8%) or cT4b (43.2%) disease, with 88.9% showing invasion near the trachea or bronchus. No significant differences were observed between the cMIE and RAMIE groups for operation time, blood loss, or common postoperative complications. However, the RAMIE group had a lower incomplete resection rate vs the cMIE group (9.0% vs 16.6%, respectively). The 3-year overall survival rate was 63.1%, with RAMIE showing slightly better survival rates compared with cMIE (p = 0.032). The prognostic factors in the RAMIE group indicated better outcomes for single-organ vs multiple-organ invasion (p = 0.036) and patients with a higher histological response (p = 0.048).

Conclusion

RAMIE may offer improved outcomes for highly locally advanced esophageal cancer, such as patients with stage T3br or T4b disease. Future studies that analyze data for high numbers of cases in multiple facilities are needed.