Robotic-Assisted Ivor Lewis Esophagectomy Is Safe and Cost Equivalent Compared to Minimally Invasive Esophagectomy in a Tertiary Referral Center.

Simple Summary: Recently, robotic-assisted minimally invasive esophagectomy (RAMIE) has become more common for patients with esophageal cancer. However, healthcare providers worried that RAMIE might be more expensive than the traditional minimally invasive esophagectomy (MIE). Therefore, we aimed to compare the results and costs of RAMIE and MIE in 128 patients who underwent surgery between 2017 and 2021. We found that surgical costs of RAMIE were higher. However, total costs were similar between RAMIE and MIE. Fewer cases of postoperative pneumonias were observed after RAMIE. RAMIE also tended to result in shorter hospital stays, which could explain why overall costs were about the same. All in all, our study suggests that RAMIE is not more expensive and might even be a better choice for many patients. In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, p < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, p = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, p = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, p = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, p = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods. [ABSTRACT FROM AUTHOR]

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