Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for resectable esophageal cancer: a systematic review and meta-analysis.

Robot-assisted minimally invasive esophagectomy (RAMIE) has emerged as an alternative to conventional minimally invasive esophagectomy (MIE) for esophageal cancer, but its short-term perioperative advantages remain uncertain. To compare early postoperative outcomes of RAMIE and MIE in patients with resectable esophageal cancer, this systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed was searched for randomized controlled trials, propensity score-matched studies, and retrospective comparative studies published between January 2005 and December 2024. Adult patients undergoing RAMIE or conventional MIE for resectable esophageal cancer were included. Random-effects models were used to pool standardized mean differences and odds ratios with 95% confidence intervals. Study quality was assessed using the MINORS criteria and Cochrane RoB 2 tool. In addition, a post hoc GRADE assessment was carried out for key outcomes to evaluate the certainty of evidence. Forty-one studies involving 13,321 patients were included, of whom 4,327 underwent RAMIE and 8,994 underwent MIE. Compared with MIE, RAMIE was associated with lower blood loss, reduced conversion to open surgery, higher total lymph node yield, greater left recurrent laryngeal nerve lymph node harvest, fewer pulmonary complications, and lower overall postoperative morbidity. ICU stay and hospital stay were also e shorter after RAMIE, whereas operative time was longer. No significant differences were observed in R0 resection, anastomotic leak, recurrent laryngeal nerve palsy, cardiac complications, chyle leak, surgical site infection, or 30- and 90-day mortality. Post hoc GRADE assessment showed that the certainty of evidence was very low across key outcomes, mainly because of the predominance of non-randomized studies, substantial heterogeneity across several pooled analyses, and outcome-specific concerns regarding imprecision and publication bias. RAMIE is safe and may offer some short-term perioperative advantages over conventional MIE without clear evidence of increased major morbidity or short-term mortality. However, the certainty of evidence across key outcomes was very low, and the predominance of nonrandomized studies and substantial heterogeneity across several analyses warrant cautious interpretation. Further adequately powered randomized trials are required.