033. PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED ESOPHAGECTOMY: A 15-YEAR COMPARATIVE ANALYSIS OF 1401 CASES WITH OPEN AND VATS

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Abstract Background Over the past 15 years, the standard surgical approach for esophageal cancer at our institution has progressed from open thoracotomy (OPEN) to video-assisted thoracoscopic surgery (VATS) and, more recently, robot-assisted minimally invasive esophagectomy (RAMIE). This study aims to evaluate short-term perioperative outcomes associated with these approaches over this period. By comparing the results of OPEN, VATS, and RAMIE, we analyzed their respective impacts and the temporal trends in surgical outcomes. These findings provide critical insights into how advancements in surgical techniques have influenced patient outcomes in esophageal cancer management. Methods We retrospectively analyzed data from January 2010 to December 2024 for patients undergoing curative thoracic esophageal cancer surgery. Of these, 1401 patients with squamous cell carcinoma treated using standard gastric tube reconstruction were included, excluding cases involving staged or colonic reconstructions. Perioperative outcomes such as anastomotic leakage, recurrent laryngeal nerve palsy (RLNP), surgical site infections (SSI) within 30 days, and pneumonia were evaluated and compared among OPEN, VATS, and RAMIE groups. This analysis focused on both short-term outcomes and temporal trends across the approaches. Results The cohort included 120 OPEN, 921 VATS, and 360 RAMIE cases. While clinical staging varied within the VATS group over time, no significant differences in cStage were observed between the OPEN, VATS, and RAMIE groups overall. RLNP occurred in 15.8%, 14.7%, and 11.1% of OPEN, VATS, and RAMIE cases, respectively, without significant differences. Anastomotic leakage rates were significantly lower in the RAMIE group (5.4%) compared to OPEN (10.7%, p = 0.02) and VATS (8.8%, p = 0.03). Although pneumonia and SSI rates showed a decreasing trend from OPEN to RAMIE, these differences were not statistically significant. Conclusion Over the past 15 years, advancements from OPEN to VATS and RAMIE were associated with significant reductions in anastomotic leakage rates. While RLNP, pneumonia, and SSI showed trends of improvement, they did not reach statistical significance. These results suggest that improvements in perioperative outcomes stem not only from evolving surgical techniques but also from enhanced perioperative management and reconstruction methods over time. Longitudinal analysis highlights the broader impacts of multidisciplinary advancements on patient care.

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