• Philippa Seika, Max M Maurer, Axel Winter, Ramin Raul Ossami-Saidy, Armanda Serwah, Paul V Ritschl, Jonas Raakow, Eva Dobrindt, Annika Kurreck, Johann Pratschke, Matthias Biebl, and Christian Denecke.
• Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany; Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. Electronic address: philippa.seika@charite.de.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 16.

BackgroundEsophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free and overall survival in oncological esophageal surgery. The adoption of robotic techniques may improve surgical outcome. However, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.MethodsAll patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome was defined as negative resection margins (R0), retrieval of >20 lymph nodes, no major complications, reinterventions, ICU readmission, 30-day readmission or mortality and hospital stay <21 days. Individual propensity scores were calculated using a logistic regression model. Factors affecting TO were evaluated using a logistic regression model while multivariate Cox proportional-hazards model was used to evaluate TO and survival.ResultsOf 236 patients included in this study, 106 (44.91%) achieved TO. TO was achieved in 71 cases after MIE (n=71 (41.21%)) and 31 after RAMIE (n=31 (57.41%)(p=0.036). RAMIE was associated with achievement of TO (OR: 2.01; 95% CI: 1.07-3.80; p=0.031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had a higher 3 year disease-free survival (DFS) rate and overall survival rate (UV: HR 2.49, 95% CI: 1.18-5.26, p=0.016; MV: HR 4.30, 95% CI: 1.60-11.55, p=0.004) compared to those without perioperative TO and disease-free survival (UV: HR 2.28, 95% CI: 1.24-4.19, p=0.008; MV: HR 2.82, 95% CI: 1.26-6.32, p=0.011) after 2 year follow up.ConclusionsRAMIE is associated with an increased TO achievement. Achieving TO is associated with enhanced long-term survival in esophageal cancer patients and warrants continued emphasis on surgical quality improvement.Copyright © 2024. Published by Elsevier Inc.

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