Robotic Esophagectomy Compared With Open Esophagectomy Reduces Sarcopenia within the First Postoperative Year: A Propensity Score- Matched Analysis

Introduction: Sarcopenia is a known risk factor for adverse outcomes after esophageal cancer (EC) surgery. Robot -assisted minimally invasive esophagectomy (RAMIE) of-fers numerous advantages, including reduced morbidity and mortality. However, no evidence exists to date comparing the development of sarcopenia after RAMIE and open esophagectomy (OE). The objective was to evaluate whether the development of sarcopenia within the first post-operative year after esophagectomy is associated with the surgical approach: RAMIE versus OE.Methods: A total of 168 patients with EC were analyzed who either underwent total robotic or fully open Ivor Lewis esophagectomy in a propensity score-matched analysis. Sar-copenia was assessed using the skeletal muscle index (cm2/ m2) and psoas muscle thickness per height (mm/m) on axial computed tomography scans during the first postoperative year; in total 540 computed tomography scans were evaluated.Results: After 1-to-1 propensity score matching for con-founders, 67 patients were allocated to RAMIE and OE groups, respectively. Skeletal muscle index in the OE group was significantly lower compared with the RAMIE group at the third (43.2 +/- 7.6 cm2/m2 versus 49.1 +/- 6.9 cm2/m2, p = 0.001), sixth (42.7 +/- 7.8 cm2/m2 versus 51.5 +/- 8.2 cm2/m2, p < 0.001) and ninth (43.0 +/- 7.0 cm2/m2 versus 49.9 +/- 6.6 cm2/m2, p = 0.015) postoperative month. Similar results were recorded for psoas muscle thickness per height.Conclusions: To our knowledge, this study is the first to suggest a substantial benefit of RAMIE compared with open esophagectomy in terms of postoperative sarcopenia. These results add further evidence to support the implementation of the robotic approach in multimodal therapy of EC. (c) 2022 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Automated summary

This study found that robot-assisted minimally invasive esophagectomy (RAMIE) is associated with a lower risk of developing sarcopenia after surgery compared to open esophagectomy (OE) for esophageal cancer. These findings provide new evidence to support the use of robotic surgery in the multimodal therapy of EC.