Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) vs. Conventional Minimally Invasive Esophagectomy (MIE) for Esophageal Cancer: A Nationwide Inpatient Sample Analysis from 2017 to 2020

Abstract

PURPOSE: This study compared the short-term outcomes after conventional minimally invasive esophagectomy (MIE) vs. robot-assisted minimally invasive esophagectomy (RAMIE)s by analyzing national data. METHODS: Data were collected from adults aged ≥20 years who underwent MIE from 2017 to 2020, from the US Nationwide Inpatient Sample database. The outcomes included in-hospital mortality, unfavorable discharges, prolonged length of stays (LOS), total hospital charge, and various complications. Propensity score matching (PSM) was employed to balance the baseline characteristics between RAMIE and conventional MIE. RESULTS: After PSM, 628 patients (representing 3140 patients in the US after weighting) were analyzed. After adjustment, multivariable analysis revealed no significant differences between RAMIE and traditional MIE in terms of in-hospital mortality (adjusted odd ratio [aOR] =1.45, 95% confidence interval [CI]: 0.46-4.61), unfavorable discharge (aOR = 0.76, 95%CI: 0.41-1.41), prolonged LOS (aOR = 0.87, 95%CI: 0.60-1.26), total hospital charge (aBeta = 12.23, 95%CI: -19.24 to 43.69), or complications (aOR = 1.05, 95%CI: 0.78-1.41). Stratified analysis indicated that, among obese patients, RAMIE was associated significantly with a higher risk of overall complications compared with MIE (aOR = 1.90, 95%CI: 1.11-3.25). CONCLUSIONS: The study found no significant differences in unfavorable discharge and prolonged LOS between RAMIE and traditional MIE. Nevertheless, obese patients undergoing RAMIE experienced higher complications.