364. IMPROVING PERIOPERATIVE OESOPHAGECTOMY OUTCOMES WITH THE USE OF ROBOTIC SURGERY AT A HIGH VOLUME UK CENTRE

Abstract Background There is a rapid movement towards adoption of robotically assisted minimally invasive oesophagectomy (RAMIO) in the United Kingdom. Transition from an open or laparoscopic oesophagectomy to a RAMIO programme, which carries considerable financial and training cost, must ensure parity of oncological and perioperative outcomes. We sought to compare our centre’s results as we performed the three standard approaches to two-phase oesophagectomy undertaken in the UK: Open/Open (Open); laparoscopic/robotic abdomen with open chest (Hybrid); and RAMIO. Methods This prospective cohort study investigated the experience of five surgeons in a single high-volume UK institution. We analysed all consecutive patients undergoing two-phase transthoracic oesophagectomy for oncological reasons between 2018 and 2023. The study period was divided into three cohorts: Open (2018-2020, n=61), Hybrid (2020-2023, n=82) and RAMIO (2023, n=61). Patient demographics, tumour characteristics, perioperative outcomes, and oncological data were compared. Data were analysed using Kruskal-Wallis and Chi-squared statistical tests. Results No significant differences were observed in patient demographics or tumour stage between the groups. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a significant reduction of major complications (Clavien-Dindo ≥III), 34.4% vs. 23.2% vs. 19.7%, respectively (p=0.033); pulmonary complications, 36.1% vs. 25.4% vs. 16.4% (p=0.007); and median length of hospital stay, 14 vs. 12 vs. 9 days (p=0.001), all favouring the RAMIO group in sub-group analysis. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a non-significant reduction in anastomotic leak rate, 11.5% vs. 2.4% vs. 6.6%, respectively (p=0.112); and mortality, 4.9% vs. 1.2% vs. 0% (p=0.19), favouring the RAMIO group. Median lymph node yields were comparable across the groups, 49 vs. 43 vs. 44 (p=0.165). Conclusions This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAMIO for oesophagectomy. RAMIO was associated with significantly reduced pulmonary complications, major complications and a shorter length of hospital stay. Oncological outcomes remained on par across techniques. These findings have important patient, financial, and resource implications, and support the continued adoption of RAMIO in the UK.