200 The Influence of Robotic Assisted Surgery on Achieving a Textbook Outcome in Oesophagectomy: A Single Centre Series

Abstract Introduction Oesophagectomy remains a highly morbid operation, in spite of advances in neoadjuvant approaches, perioperative care, and minimally invasive surgery. Textbook outcome (TBO) is a composite metric assessing surgical quality and perioperative outcomes. Our group has previously demonstrated a survival advantage with a TBO. Additionally, operating by a minimally invasive approach combined with TBO further improves survival. Robotic assisted minimally invasive oesophagectomy (RAMIO) is oncologically safe and may improve perioperative outcomes. This study aims to determine rates of TBO in RAMIO, and compare this with a pre-existing cohort. Method Patients undergoing oesophagectomy from 2011-2024 were included. Only patients undergoing RAMIO were included post-February 2020. Standard clinicopathologic variables were recorded. TBOs were calculated as previously described1. Statistical analyses were performed with jamovi 2.3.28. Results 362 patients underwent oesophagectomy. 93 had a RAMIO, 139 underwent open oesophagectomy (OO) and 130 underwent laparoscopic oesophagectomy (LO). 53% of RAMIO patients achieved a TBO, compared with 19% of OO and 45% LO (p=0.001, 0.34). For the RAMIO group the most common reason for not achieving a TBO was a post-operative complication (39%), followed by a prolonged length of stay (19%), similar to the non-RAMIO group (32% and 28% respectively). In the RAMIO group there were no associations between age, ASA status, patient sex and neoadjuvant regimen and the likelihood of achieving a TBO. Conclusions The introduction of RAMIO incrementally improve TBO rates, particularly compared with OO. As the use of RAMIO expands, there may be a corresponding incremental impact on long-term oncologic outcomes.