• Philippa Seika, Max M Maurer, Axel Winter, Ramin Raul Ossami-Saidy, Armanda Serwah, Paul V Ritschl, Jonas Raakow, Eva Dobrindt, Annika Kurreck, Johann Pratschke, Matthias Biebl, and Christian Denecke.
• Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address: philippa.seika@charite.de.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 16.

BackgroundEsophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free survival (DFS) and overall survival (OS) in patients undergoing oncologic esophageal surgery. The adoption of robotic techniques may improve surgical outcomes; however, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.MethodsAll EC patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome (TO) was defined as negative resection margin (R0), retrieval of >20 lymph nodes, no major complications, no reinterventions, no intensive care unit readmission, no 30-day readmission or mortality, and hospital stay <21 days. Individual propensity scores were calculated using a logistic regression model. Factors affecting TO were evaluated using a logistic regression model, and a multivariate Cox proportional hazards model was used to evaluate TO and survival.ResultsOf 236 patients included in this study, 106 (44.91%) achieved TO. TO was achieved in 71 patients after MIE (41.21%) and in 31 patients after RAMIE (57.41%; P = .036). RAMIE was associated with achievement of TO (odds ratio, 2.01; 95% confidence interval [CI], 1.07-3.80; P = .031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had higher 3-year DFS and OS rates (univariate analysis [UV]: hazard ratio [HR], 2.49; 95% CI, 1.18-5.26; P = .016; multivariate analysis [MV]: HR, 4.30; 95% CI, 1.60-11.55; P = .004) compared to those without perioperative TO and disease-free survival (UV: HR, 2.28; 95% CI, 1.24-4.19; P = .008; MV: HR, 2.82; 95% CI, 1.26-6.32; P = .011) at the 2-year follow-up.ConclusionsRAMIE is associated with increased TO achievement. Achieving TO is associated with enhanced long-term survival in EC patients and warrants continued emphasis on surgical quality improvement.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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