Robotic versus Thoracoscopic-Assisted Esophagectomy for Esophageal Cancer: Initial Experience Comparing Perioperative Outcomes and CUSUM Learning Curve Analysis.

Abstract

Robotic-assisted thoracoscopic surgery (RATS) offers enhanced precision and ergonomics in esophageal cancer surgery compared to video-assisted thoracoscopic surgery (VATS). However, its clinical advantage remains debated, and adoption is limited by financial and learning curve challenges. We conducted a retrospective analysis of 68 patients undergoing transthoracic radical esophagectomy between July 2022 and October 2024 at a high-volume centre. Patients were allocated to RATS (n = 31) or VATS (n = 37) based on preference following informed consent. Demographics, perioperative outcomes, and lymph node yield were compared. The learning curve for RATS was assessed by cumulative sum (CUSUM) analysis of operation time and lymph node yield. Baseline characteristics were similar between groups. The RATS group had a longer operative time (314.8 ± 7.8 min vs. 298.5 ± 15.4 min; p < 0.001) but higher lymph node yield (20.7 ± 7.9 vs. 18.3 ± 6.5; p = 0.038). Postoperative complication rates, readmissions, and mortality were comparable. CUSUM analysis showed proficiency in RATS was achieved at case 16 for operative time and case 14 for lymph node yield. RATS and VATS offer comparable short-term outcomes in transthoracic esophagectomy. RATS enables superior lymphadenectomy with an acceptable learning curve plateauing within 16 cases. Broader adoption remains constrained by financial and accessibility barriers. Further studies evaluating long-term outcomes and cost-effectiveness are warranted.