P1.220. Totally Versus Hybrid Robot-Assisted Minimally Invasive Esophagectomy for Thoracic Esophageal Cancer: Similar Perioperative Safety and Oncologic Survival

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background This study compared the perioperative safety, quality of life and oncologic outcomes of the totally robot-assisted minimally invasive esophagectomy (ToRaMIE) technique with hybrid robot-assisted thoracoscopic and laparoscopic esophagectomy with an abdominal mini-incision (HyRaMIE). Methods The ToRaMIE procedure is performed as follows (Figure 1A). The thoracic esophagus is mobilized via a right thoracoscopic approach using the Da Vinci Xi robotic surgical system, with concurrent mediastinal lymph node dissection. Subsequently, the entire stomach is mobilized robotically via a robotic laparoscopic approach. The esophagus is transected at the esophagogastric junction using a linear stapler. A gastric conduit is created entirely intracorporeally and secured to the proximal stomach at the resection staple line. It is then delivered through a retrosternal tunnel to the left neck incision with robotic assistance. The cervical esophagus is mobilized through the left neck incision, and the thoracic esophagus along with the resected gastric tissue is removed. Finally, a stapled end-to-side esophagogastric anastomosis is created. Results From October 2024 to October 2025, 25 and 23 patients underwent ToRaMIE and HyRaMIE, respectively. Most patients had upper and middle thoracic esophageal tumors. No significant differences were observed between the two groups in terms of R0 rate, blood loss or the number of lymph nodes dissected, except for a longer operative time in the ToRaMIE group (271 vs. 248 min, p=0.045). The overall complication rates (28.0% vs. 30.4%, Figure 1B), postoperative pain scores (Figure 1C), and hospital stay duration (9.5 vs. 9.6 days) were similar between the groups. Furthermore, no significant difference was found in quality-of-life scores at 1 month (61.7 vs. 54.3) and 3 months (63.0 vs. 59.4) postoperatively (Figure 1D). At the latest follow-up, one patient in each group had developed distant metastasis, with comparable recurrence-free survival rates observed. Conclusion ToRaMIE is a safe procedure for thoracic esophageal cancer. Long-term survival is needed.