Comparison of Short-Term Outcomes Between Robot-Assisted and Conventional Mediastinoscopic Esophagectomies: A Retrospective Study Using Propensity Score Matching.

backgroundMediastinoscopic esophagectomy (ME) is a minimally invasive surgery for esophageal cancer that avoids one-lung ventilation and chest wall trauma. However, a major challenge with this technique is the relatively high incidence of left recurrent laryngeal nerve palsy (RLNP). To address this, we introduced a transcervical mediastinoscopic and transabdominal robot-assisted esophagectomy (RA-ME) technique. The clinical significance of robotic assistance in ME was evaluated by comparing RA-ME and conventional ME (Co-ME), using propensity score matching (PSM) to control for baseline characteristics.

methodsWe retrospectively reviewed patients who underwent ME for esophageal or esophagogastric junction cancer between April 2018 and March 2025. Patients were classified into RA-ME and Co-ME groups. PSM was performed using five covariates, resulting in 68 matched pairs (n = 136). The primary endpoint was the incidence of left RLNP, whereas secondary endpoints included operative time, blood loss, complications, lymph node yield, and R0 resection rate.

resultsA total of 136 matched patients (RA-ME, n = 68; Co-ME, n = 68) were analyzed after PSM. The RA-ME group had a significantly lower RLNP incidence (19.1% vs 38.2%, p = 0.022) and less intraoperative blood loss than the Co-ME group (99.8 ± 116.1 mL vs 251.0 ± 821.1 mL, p = 0.001). Operative time, complication rates, lymph node yield, and R0 resection rates were comparable between the groups.

conclusionsRA-ME significantly reduced RLNP incidence, nearly halving it, and lowered intraoperative blood loss without compromising oncologic quality. These findings support the potential use of RA-ME as a standard approach in select cases of minimally invasive esophageal cancer surgery.