Robotic Ivor Lewis esophagectomy experience and outcomes from a high-volume cancer center with propensity-matched comparative assessment to the ACS-NSQIP database.

BACKGROUND: Adoption of minimally invasive techniques for esophagectomy has increased and has become preferred compared to open esophagectomy (OE). The purpose of this study is to report the experience of a high-volume cancer center compared to a contemporary OE series from the ACS-NSQIP database. METHODS: Single institution retrospective study from a prospective database of 1,448 patients undergoing esophagectomy. Included patients underwent elective robotic Ivor Lewis esophagectomy (RILE) for non-metastatic esophageal cancer. Patients were matched by demographic and oncologic preoperative characteristics and outcomes were compared to the 2016-2023 ACS-NSQIP esophagectomy targeted database. RESULTS: From 2010 to 2025, 649 robotic total esophagectomies were performed with 582 patients undergoing elective RILE. Patients were predominantly white males, 66 (IQR: 58-71) years old, BMI of 27.2 (24.2-30.8), ASA of 3, 466 patients received neoadjuvant chemotherapy, and 459 patients received radiation. Median operative time was 421 (IQR: 383-470) minutes, estimated blood loss was 150 (IQR: 100-250) mL, 23 (Range: 4-64) lymph nodes were harvested, and R0 resection was obtained 95.7%. One hundred eighty-nine patients were matched 1:1 to ACS-NSQIP OE control preoperative variables. Patients who underwent RILE had decreased serious morbidity (14.3% vs. 26.5%, p = 0.003), reoperation (2.6% vs. 14.3%, <0.001), pulmonary complications (12.2% vs. 22.2%, p = 0.010), and length of stay (9 vs. 10 days, p < 0.001). Operative time (415 vs. 323 min, p < 0.001) was longer in the RILE cohort. There was no difference in leak rate or 30-day mortality. CONCLUSION: In this large single institutional series of over 15 years of performing RILE, we report favorable perioperative outcomes compared to the contemporary national open esophagectomy cohort from the ACS-NSQIP database.