The rise of robotic-assisted esophagectomy: a game-changer or just an added cost—a narrative review

Background and Objective: Robotic-assisted minimally invasive esophagectomy (RAMIE) has emerged as a promising alternative to open and conventional minimally invasive esophagectomy (cMIE) for treating esophageal cancer. While prior studies have examined the perioperative and oncologic outcomes of RAMIE, much of the literature has focused on comparisons with cMIE without adequately addressing the rapid evolution of robotic platforms, surgical technique, and training paradigms. Additionally, gaps remain in understanding the economic implications, feasibility of broad implementation, and long-term outcomes including survival, recurrence, and cost-effectiveness. This narrative review aims to synthesize current evidence on RAMIE, with emphasis on its technical development, clinical outcomes, and potential advantages over cMIE. Methods: A comprehensive search of PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar was conducted to identify peer-reviewed articles related to RAMIE published between 2000 and 2025. The search included terms such as “robotic esophagectomy”, “RAMIE”, “robot-assisted surgery”, “minimally invasive esophagectomy”, “esophageal cancer”, “learning curve”, “cost-effectiveness”, “lymphadenectomy”, and “oncologic outcomes”. Key Content and Findings: RAMIE has shown favorable perioperative outcomes in some studies, including reduced pulmonary complications, and may result in less postoperative pain compared to cMIE. However, these benefits are often modest and not consistently observed across all comparative studies. It may also be associated with improved early functional recovery and short-term quality of life. Oncologic outcomes, including R0 resection rates, lymph node harvest, and overall and disease-free survival, appear comparable between RAMIE and cMIE. However, RAMIE is consistently associated with longer operative times, largely due to its technical complexity and learning curve. The widespread adoption of RAMIE is challenged by its high cost, the need for advanced surgical training, and limited access to robotic platforms across institutions. Conclusions: RAMIE represents a significant advancement in esophageal surgery, offering improved precision, visualization, and perioperative safety while maintaining oncologic efficacy. Despite its potential benefits, barriers such as cost, training requirements, and technological access hinder widespread use. Further research is needed to assess long-term outcomes, refine training pathways, and evaluate cost-effectiveness to support broader adoption. As robotic systems continue to evolve, RAMIE may play an increasingly central role in the surgical management of esophageal cancer.