ORIGINAL RESEARCH article
Front. Oncol.
Sec. Surgical Oncology
This article is part of the Research TopicAdvances in Esophageal Cancer: Treatment Updates and Future ChallengesView all 29 articles
Robot-assisted Minimally Invasive EsophagectomyRobot-assisted esophagectomy versus video-assisted thoracoscopic esophagectomy versus open esophagectomy for locally advanced esophageal cancer after neoadjuvant therapy: a systematic review and network meta-analysis
Provisionally accepted
- 1Department of Cardiology, Chengdu Integrated TCM and Western Medical Hospital, Chengdu, Sichuan Province, China
- 2Department of Thoracic Surgery, West China Fourth Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Background: Esophageal cancer (EC) remains a lethal malignancy with poor survival outcomes despite multimodal therapy. While minimally invasive techniques like video-assisted thoracoscopic esophagectomy (VATE) and robot-assisted minimally invasive esophagectomy (RAMIE)robot-assisted esophagectomy (RAE) have gained traction over open esophagectomy (OE), their comparative safety, efficacy, and survival benefits in patients receiving neoadjuvant therapy remain underexplored. Methods: We conducted a Bayesian network meta-analysis on data from seven studies (n=1847 patients) to compare OE, VATE, and RAMIERAE after neoadjuvant therapy for locally advanced EC. Outcomes included complication rates, operative time, R0 resection, lymph node yield, and 3-year overall survival (OS). Results: No significant differences were observed in R0 resection rates (RAMIE vs. OE: OR=1.03, 95% CI 0.25–4.70; VATE vs. OE: OR=1.37, 0.67–3.45), lymph node dissection (RAMIE vs. OE: WMD=1.56, −3.29–6.43; VATE vs. OE: WMD=1.05, −2.24–4.53), or 3-year OS (VATE vs. OE: HR=1.14, 0.70–1.85). RAMIE ranked highest for reducing complications (SUCRA=52.5%), while OE showed shorter operative time (SUCRA=94.0%). Achieving R0 resection ranking: RAE (SUCRA 47.3%), OE (SUCRA 43.8%), and VATE (SUCRA 8.9%). In lymph node dissection, OE had the highest probability of being superior (59.5%), markedly outperforming RAMIE (21.3%) and VATE (19.2%). Survival outcomes were comparable across all approaches. Conclusions: OE, VATE, and RAMIE demonstrate equivalent oncological efficacy in EC after neoadjuvant therapy. Perioperative advantages differ: RAE may lower complications, whereas OE offers procedural efficiency. Surgical selection should prioritize individualized risk-benefit assessment, anatomical considerations, and institutional expertise. Prospective trials are warranted to validate these findings and refine technique-specific indications.
Keywords: esophageal cancer, Neoadjuvant Therapy, Esophagectomy, minimally invasive surgery, Robot-assisted surgery, Network meta-analysis
Received: 20 May 2025; Accepted: 30 Oct 2025.
Copyright: © 2025 Zhou, Zheng, Zhou, Liu, Chen, Lu and Yuan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang Yuan, yuanyang12251990@163.com
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