Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 May;39(5):2994-3005.
doi: 10.1007/s00464-025-11666-9. Epub 2025 Mar 21.

Short-and middle-term outcomes of robot-assisted minimally invasive esophagectomy for highly locally advanced esophageal cancer with stage cT3 borderline and cT4b at initial diagnosis

Takeo Fujita  1 , Kazuma Sato  2 , Daisuke Kajiyama  2 , Yuto Kubo  2 , Naoto Fujiwara  2 , Hiroyuki Daiko  3
Affiliations
Comparative Study

Short-and middle-term outcomes of robot-assisted minimally invasive esophagectomy for highly locally advanced esophageal cancer with stage cT3 borderline and cT4b at initial diagnosis

Takeo Fujita et al. Surg Endosc. 2025 May.

Abstract

Background: Although the efficacy of robot-assisted minimally invasive esophagectomy (RAMIE) in locally advanced esophageal cancer has been suggested, solid evidence is lacking. In this study, we examined the short- and middle-term outcomes of RAMIE in patients with highly locally advanced esophageal cancer who were initially diagnosed with cT3 borderline resectable or cT4b (cT3br/cT4b) disease and deemed resectable after preoperative treatment. Furthermore, we compared the short- and middle-term outcomes of RAMIE with conventional minimally invasive esophagectomy (cMIE).

Methods: Eighty-one patients with locally advanced initial T3br and T4 esophageal squamous cell carcinoma previously treated with chemotherapy or chemoradiation underwent minimally invasive esophagectomy with curative intent between 2018 and 2022. We then examined the short- and long-term outcomes of RAMIE compared with cMIE in patients initially diagnosed with stage cT3br/cT4b disease.

Results: Among these 81 patients, 33 underwent RAMIE and 48 underwent cMIE. The average age of the 81 patients was 65.8 years, with tumors located primarily in the mid-esophagus (55.6%). Most patients initially had stage cT3br (56.8%) or cT4b (43.2%) disease, with 88.9% showing invasion near the trachea or bronchus. No significant differences were observed between the cMIE and RAMIE groups for operation time, blood loss, or common postoperative complications. However, the RAMIE group had a lower incomplete resection rate vs the cMIE group (9.0% vs 16.6%, respectively). The 3-year overall survival rate was 63.1%, with RAMIE showing slightly better survival rates compared with cMIE (p = 0.032). The prognostic factors in the RAMIE group indicated better outcomes for single-organ vs multiple-organ invasion (p = 0.036) and patients with a higher histological response (p = 0.048).

Conclusion: RAMIE may offer improved outcomes for highly locally advanced esophageal cancer, such as patients with stage T3br or T4b disease. Future studies that analyze data for high numbers of cases in multiple facilities are needed.

Keywords: Conversion esophagectomy; Esophagectomy; Robotic surgery; cT3 borderline; cT4b.

PubMed Disclaimer

Conflict of interest statement

Declarations. Disclosures: Takeo Fujita, Kazuma Sato, Naoto Fujiwara, Daisuke Kajiyama, Yuto Kubo, and Hiroyuki Daiko have no conflicts of interest or financial ties to disclose. Ethical approval: The study protocol was approved by the Committee for Ethics of the National Cancer Center (Japan) (approval number #2018-332) and was performed in accordance with the tenets of the Declaration of Helsinki. Informed consent was obtained from all study participants. Consent for publication: Not applicable.

Similar articles

See all similar articles

References

    1. Zhao YX, Zhao HP, Zhao MY, Yu Y, Qi X, Wang JH, Lv J (2024) Latest insights into the global epidemiological features, screening, early diagnosis and prognosis prediction of esophageal squamous cell carcinoma. World J Gastroenterol 30:2638–2656 - DOI - PubMed - PMC
    1. Xu J, Bai Y, Li E, Xu N, Shi D, Qian J (2022) Efficacy and safety of chemotherapy regimens for first-line treatment of advanced esophageal squamous cell carcinoma in Asia: a systematic review. Exp Rev Anticancer Ther 22:981–998 - DOI
    1. Chen W, Cao K, Zhang L, Zhao X, Chen B, Li W, Shang R, Sun L, Jiang Z, Wang J, Xue W (2024) Efficacy and safety evaluation of frontline immunotherapy combinations in advanced esophageal squamous cell carcinoma: a network meta-analysis highlighting the value of PD-L1 expression positivity scores. Front Immunol 10:1414753 - DOI
    1. Fick CN, Dunne EG, Sihag S, Molena D, Cytryn SL, Janjigian YY, Wu AJ, Worrell SG, Hofstetter WL, Jones DR, Gray KD (2024) Immunotherapy for resectable locally advanced esophageal carcinoma. Ann Thorac Surg 118:130–140 - DOI - PubMed
    1. Hngorani M, Jain P (2023) The role of surgery or definitive chemoradiotherapy in management of localized squamous cell carcinoma of esophagus—What is the verdict? Crit Rev Oncol Hematol 190:104111 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources