RAMIE versus open esophagectomy for esophageal cancer: comparison of outcomes

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Background: Robotic surgery has been shown to improve the perioperative course and potentially also the tumor-associated overall survival in esophageal cancer, as compared to open conventional esophagectomy (OE) Aims: Here, we compared the perioperative outcomes of robot-assisted (RAMIE, DaVinci Xi) vs. open conventional esophagectomy in a high-volume university hospital. Methods: We prospectively collected numeric data on surgery-related technical details of all our upper GI robotic cases in the study period Results: Between April 2022-November 2024, we compared the outcome of RAMIE (n=42) with open conventional Ivor-Lewis esophagectomy / OE (n=144) from our institution. The most common diagnosis was AEG Siewert type II (n=36 for RAMIE, n=111 for OE), followed by squamous cell cancer (n=6 for RAMIE vs. n=33 for OE). The median operating time was significantly shorter for OE when compared to RAMIE (152 min. vs. 290 min.), whereas the median hospital stay was comparable (16d for OE vs. 19.2 d for RAMIE). The anastomotic leak rate tended to be higher in the RAMIE group, yet with no statistical significance (13/42=30% vs. 25/144=17.3%). There was no difference in the rate of Clavien-Dindo grade 0-2 or 3-4 complications. Similarly, the in-hospital mortality (3/144 for OE=2.1% vs. 2/42=4.8% for RAMIE) and re-admission rate was similar (18% for OE vs. 11.9% for RAMIE). Conclusions: RAMIE offers comparable perioperative results as OE in centers that have long-standing experience in OE. The longer median operative times of RAMIE were in this series not counterbalanced / compensated by any difference in the complication rates or morbidity. Publication History Article published online: 04 September 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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