BackgroundCurrently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE).MethodsThis retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers.ResultsAfter propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml,p= 0.6967), operational time (mean 430.3 min versus 417.7 min,p= 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%,p= 0.560), radical resection (R0) rate (95.6% versus 96.3%,p= 0.8526) and total lymph node yield (mean 30.4 versus 29.5,p= 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%,p= 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%,p< 0.001). The length of stay on intensive care unit (median 3 days versus 2 days,p= 0.0005) and in-hospital (median 15 days versus 12 days,p< 0.0001) were longer for the hybrid laparoscopic RAMIE group.ConclusionsHybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.