Da Vinci Surgical System Xi was introduced in our institution in 2017. Since then we started robot-assisted minimally invasive esophagectomy (RAMIE) as private practice. Japanese national insurance system started to reimburse RAMIE in 2018. Since then, the number of RAMIE is explosively increasing. Currently the indication of RAMIE in our institution purely depends on machine availability. However, the real clinical benefit of RAMIE over conventional minimally invasive esophagectomy (MIE) remains unknown. Methods Between January 2015 and January 2020, data of 156 consecutive patients with esophageal carcinoma undergoing esophagectomy was retrospectively reviewed. After exclusion of 12 salvage esophagectomy for patients after definitive chemoradiotherapy (>50Gy), 10 mediastinoscopic esophagectomy, 5 esophagectomy without upper mediastinal dissection, 2 two-stage esophagectomy and 1 total pharyngo-laryngo-esophagectomy, 126 patients (46 RAMIE and 80 MIE) were included in the analysis. The 1:1 propensity score match analysis was performed to compare the short-term outcomes between RAMIE and MIE. Results After matching, 45 RAMIE and 45 MIE were analyzed. RAMIE took significantly longer thoracic operation time (370 min vs. 288 min; P < 0.0001). Intraoperative blood loss (80 g vs. 50 g; P = 0.0759), harvested thoracic nodes (22 vs 25; P = 0.1188), harvested upper mediastinal nodes (12 vs 12; P = 0.4233) were similar. RAMIE showed less severe postoperative morbidity (Clavien-Dindo Grade III or higher) (9% vs. 22%; P = 0.0810) and lower incidence of recurrent laryngeal nerve palsy (Clavien-Dindo Grade II or higher) (7% vs. 18%; P = 0.1076). There was no postoperative death in both groups. Conclusion Although this result contains our early learning curve period of RAMIE, short term outcome of RAMIE is acceptable from a safety point of view.

中文翻译：

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112 即使在学习曲线期也可以进行机器人辅助的微创食管切除术；倾向得分匹配分析

达芬奇手术系统 Xi 于 2017 年引入我们的机构。从那时起，我们开始将机器人辅助微创食管切除术 (RAMIE) 作为私人诊所。日本国民保险制度于 2018 年开始报销 RAMIE，此后 RAMIE 的数量呈爆发式增长。目前，我们机构中 RAMIE 的指示完全取决于机器的可用性。然而，RAMIE 相对于传统微创食管切除术 (MIE) 的真正临床益处仍然未知。方法对2015年1月至2020年1月连续156例食管癌行食管切除术患者的资料进行回顾性分析。排除根治性放化疗 (>50Gy) 后的 12 例挽救性食管切除术，10 例纵隔镜食管切除术，5例食管切除术无上纵隔切除术，2例二期食管切除术和1例全咽喉食管切除术，126例患者（46例RAMIE和80例MIE）被纳入分析。进行 1:1 倾向得分匹配分析以比较 RAMIE 和 MIE 之间的短期结果。结果匹配后，分析了45个RAMIE和45个MIE。RAMIE 的胸部手术时间显着延长（370 分钟对 288 分钟；P < 0.0001）。术中失血量（80 g vs. 50 g；P = 0.0759）、胸廓淋巴结（22 vs 25；P = 0.1188）、上纵隔淋巴结（12 vs 12；P = 0.4233）相似。RAMIE 的术后发病率较低（Clavien-Dindo III 级或更高）（9% 对 22%；P = 0.0810）和喉返神经麻痹发生率较低（Clavien-Dindo II 级或更高）（7% 对 18 %；P = 0.1076)。两组均无术后死亡。结论 尽管该结果包含我们对 RAMIE 的早期学习曲线期，但从安全的角度来看，RAMIE 的短期结果是可以接受的。