Robotic-Assisted Ivor Lewis Esophagectomy (RAILE): a comparative analysis of a single unit, consecutive series of Open, Hybrid, and Robotic approaches

Esophago-gastrectomy has historically been associated with high morbidity and mortality rates. Minimally invasive surgery has been proposed as a solution to this problem. There has been a rapid adoption of robotic-assisted minimally invasive esophagectomy, despite concerns regarding the published morbidity and anastomotic leak rates. We present outcomes from our unit's experience of two-phase (Ivor Lewis) esophago-gastrectomies, from Open through Hybrid, and our first 170 Robotic-Assisted Ivor Lewis esophago-gastrectomy (RAILE) cases. This retrospective cohort study investigated our experience in a single UK institution from 2017 to 2025. We analyzed our prospectively maintained database for patients undergoing two-phase transthoracic esophagectomy for oncological reasons. The study was divided into three consecutive cohorts: Open (n = 100), Hybrid (n = 82), and RAILE (n = 170). No significant differences were observed in patient demographics or tumor stage between the groups. Comparison of Open vs. Hybrid vs. RAILE demonstrated a significant reduction in major complications (Clavien-Dindo ≥IIIb), 20.0% vs. 12.2% vs. 8.8% (P = 0.0289); pulmonary complications, 36.0% vs. 25.6% vs. 17.1% (P = 0.0021); and median length of hospital stay, 14 vs. 12 vs. 8 days (P ≤ 0.0001). Comparison of Open vs. Hybrid vs. RAILE demonstrated a significant reduction in anastomotic leak rate, 12.0% vs. 2.4% vs. 4.1%, respectively (P = 0.0094). Median lymph node yields were comparable across the groups, 48 vs. 43 vs. 41 (P = 0.1871). This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAILE for esophagectomy. These findings have important patient and resource implications that support the continued evaluation of RAILE.