225. LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED VERSUS CONVENTIONAL OPEN ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: PROPENSITY-SCORE MATCHED ANAYLSIS

Abstract Background This study aimed to compare the long-term oncologic outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) with those of conventional open esophagectomy (OE) for esophageal cancer. Methods Between January 2006 and December 2021, 1,745 consecutive patients underwent esophagectomy for esophageal cancer at our institution. Among them, we retrieved 1,133 patients (mean age 63.1±7.8 years, 86 [7.6%] women, 1,100 [97.1%] squamous cell carcinomas), who were operated by a single surgeon. These patients were categorized into following two groups based on their surgical approaches: RAMIE (n = 497) and OE (n = 636). The RAMIE and OE groups were matched in a 1:1 ratio using propensity scores. Results Median follow-up was 51.8 months. Five-year overall survival (OS, 70.7% vs. 55.0%) and recurrence-free survival (RFS, 63.3% vs. 50.1%) rates were significantly higher in RAMIE than in OE group (P < 0.01). Following propensity-score matching, 886 patients (443 pairs) were successfully matched, demonstrating no significant intergroup differences. The RAMIE group consistently demonstrated enhanced OS (70.4% vs. 61.8%, P < 0.01) and RFS (62.8% vs. 55.8%, P=0.04) after five years, even after adjustment (Figure). The rate of noncancer mortality was significantly higher in the OE group (P < 0.01), whereas the esophageal cancer-related mortality showed no significant differences (P = 0.25). Conclusions RAMIE could be a safer and more feasible option for patients compared with conventional open esophagectomy with favorable long-term oncologic outcomes.