Robotic versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Cancer After Neoadjuvant Therapy: A Dual-Center Retrospective Study.

OBJECTIVES

Data on robot-assisted minimally invasive esophagectomy (RAMIE) after neoadjuvant therapy, particularly after neoadjuvant immunochemoradiotherapy, remain scarce. This study compares the perioperative outcomes of RAMIE versus conventional minimally invasive esophagectomy (MIE) in patients with resectable esophageal cancer after neoadjuvant therapy.

METHODS

We conducted a dual-center, retrospective study of consecutive patients with esophageal cancer who underwent MIE after neoadjuvant chemoradiotherapy or neoadjuvant immunochemoradiotherapy between 2020 and 2025. Propensity score matching was applied based on preoperative variables. Perioperative outcomes were analyzed.

RESULTS

After 1:1 propensity score matching, 137 patients were allocated to each group. The RAMIE group demonstrated a higher rate of left recurrent laryngeal nerve lymph node dissection (67.9% vs. 53.3%, p = 0.02) and yielded more lymph nodes in this station after neoadjuvant chemoradiotherapy (mean 1.6 vs. 1.0, p = 0.02). However, RAMIE was associated with a higher overall incidence of postoperative complications (38.0% vs. 24.8%, p = 0.03). No significant differences were observed in operation time, pathological complete response rate, severe complications, length of stay, 30-day readmission, or 90-day mortality.

CONCLUSIONS

In expert hands, RAMIE achieves perioperative safety comparable to that with MIE after neoadjuvant therapy and offers a superior ability to dissect critical lymph node stations. This technical advantage establishes RAMIE as a viable and promising surgical option, warranting further prospective investigation in randomized trials.