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Table 4. Post-operative and long-term oncological outcomes.
Author Induction therapy Tumor type Mean n dissected Radicality 3yOS 5yOS DFS
lymph nodes
Boone et al. [18] 3 (4%) ADC 29 (61.7%) 29 36 (76.6%) NA NA NA
SCC 18 (38.3%)
Puntambekar et al. [27] NA NA NA NA NA NA
Dunn et al. [19] 17 (42,5%) ADC 36 (90%) 20 94.7% NA NA NA
SCC 2 (5%)
Sarkaria et al. [21] 16 (76%) ADC 18 (85%) 20 17 (85%) NA NA NA
SCC 3 (14%)
Suda et al. [32] NA SCC 100% 37.5 14 (87.5%) NA NA NA
de la Fuente et al. [36] 35(70%) ADC 46 (92%) 20 100% NA NA NA
SCC 3 (6%)
Yerokun et al. [39] 120 (70.6%) ADC 186 (80.5%) 16 NA NA NA NA
SCC 45 (19.5%)
Weksler et al. [17] 412 (70,9%) ADC (78.3%) 16 553 (95.2%) 48 months 48 months NA
SCC (21.7%)
van der Sluis et al. [14] 49 (94%) ADC 41 (76%) 27 50 (93%) 50% 50% 26m
SCC 13 (24%)
Harbison et al. [16] ADC 68 (68%) NA NA NA NA NA
SCC 8 (8%)
Yang et al. [22] 30 (10.7%) NA 19.3 263 (93.9%) NA NA NA
Tagkalos et al. [28] NA NA 27 NA NA NA NA
Sarkaria et al. [31] 48 (75%) ADC 59 (93.7%) 25 62 (96.9%) 81.7% NA NA
SCC 4 (6.3%)
Yun et al. [29] 21 (16.2%) SCC 130 (100%) 39 127 (97.7%) 81.7% NA 49.2%
3yOS: three years overall survival; 5yOS: five years overall survival; DFS: disease-free survival; ADC: adenocarcinoma; SCC: squamous
cell carcinoma; NA: not available

Esophageal (FACT-E) and Functional Assessment of Cancer Therapy-General (FACT-G) scores,
demonstrating a return to pre-operative values only after four months, without difference between OE
or RAMIE. van der Sluis et al. administered some validated questionnaires (Short Form-36, EORTC-
[14]
European Organisation for Research and Treatment of Cancer-Quality-of-life Questionnaire Core 30,
EORTC QLQ-OES18-Quality of Life Questionnaire Oesophageal Cancer Module-and EQ-5D-EuroQoL-5-
Dimension) at discharge and six weeks after esophagectomy, demonstrating that functional recovery after
RAMIE was better and faster than after OE.

Oncological outcomes
[17]
Long-term outcomes after RAMIE are still scarce, but data from a large multi-center study and from the
only RCT showed encouraging results [Table 4]. Trans-thoracic esophagectomy seems to ensure more
[14]
extensive lymph node dissection than the trans-hiatal approach and in particular, the mean number of
retrieved lymph nodes was reported between 5 and 39. Furthermore, trans-thoracic esophagectomy was
associated with a complete resection rate between 76.6% and 100%. On the other hand, few papers have
[12]
reported long-term oncological results: the only RCT showed that there were no statistically significant
differences between OE and RAMIE in overall survival (OS) (log rank P = 0.427) at 40 months of follow-
up. Moreover, the authors demonstrated no statistical differences regarding disease-free survival (DFS) (26
for RAMIE vs. 28 months for OE) and recurrence pattern.

[17]
In their analysis of the National Cancer Data Base (NCDB), Weksler et al. showed 48 months of overall
survival after RAMIE, this outcome was not different in comparison with the oncological results obtained
by OE and MIE also after the propensity-matched analysis (P = 0.121 and P = 0.53). With the magnified
view and extreme precision of the articulated instruments, RAMIE is increasingly being used after
induction treatments: in the RCT, 79% of patients were previously treated with chemo-radiation and in
other studies, a large portion of patients were treated before surgery with chemotherapy alone (70.9%-75%) [16,17]
or combined treatments (68%-75%) [17,21,39] .