Achieving Textbook Outcomes with Robotic Assisted Ivor Lewis Esophagectomy: A Single Center Experience with 150 Consecutive Patients.

INTRODUCTION: With published randomized data, minimally invasive esophagectomy (MIE) is becoming more popular, however a sizable variability in techniques and outcomes still exist. METHODS: This is a retrospective analysis of 150 consecutive robotic assisted minimally invasive esophagectomies (RAMIE) from a prospectively maintained database from 2020-2024, at a single comprehensive cancer center. We aim to evaluate the textbook outcome rate after RAMIE. RESULTS: 150 consecutive patients underwent RAMIE from 2020 -2024. Tumor location included esophagus in 18, type 1 GE junction in 52, type 2 in 71, and type 3 in 9 patients. Majority of patients had clinical stage T3 tumors. Neoadjuvant therapy was utilized in 85%. Complete pathologic response was seen in 27%. Median number of lymph nodes retrieved were 21. Anastomotic leak occurred in 2 patients, none requiring a reoperation. Median hospital stay was 7 days. Thirty day and 90-day mortality were 0.7% and 1.3% respectively. 90-day stricture with endoscopic dilation was also 0.7%. 90% patients had a textbook outcome. CONCLUSIONS: This single center experience highlights that a combination of robotic platform and a side-to-side stapled anastomotic technique helps achieve exceptional postoperative outcomes for MIE with a textbook outcome rate of 90%. With increasing worldwide adoption of MIE, this seems to be an appropriate time to standardize operative technique to optimize postoperative outcomes.