TY - JOUR
T1 - Surgical Techniques and Related Perioperative Outcomes After Robot-assisted Minimally Invasive Gastrectomy (RAMIG)
T2 - Results From the Prospective Multicenter International Ugira Gastric Registry
AU - de Jongh, Cas
AU - Cianchi, Fabio
AU - Kinoshita, Takahiro
AU - Kingma, Feike
AU - Piccoli, Micaela
AU - Dubecz, Attila
AU - Kouwenhoven, Ewout
AU - van Det, Marc
AU - Mala, Tom
AU - Coratti, Andrea
AU - Ubiali, Paolo
AU - Turner, Paul
AU - Kish, Pursnani
AU - Borghi, Felice
AU - Immanuel, Arul
AU - Nilsson, Magnus
AU - Rouvelas, Ioannis
AU - Hӧlzen, Jens Peter
AU - Rouanet, Philippe
AU - Saint-Marc, Olivier
AU - Dussart, David
AU - Patriti, Alberto
AU - Bazzocchi, Francesca
AU - van Etten, Boudewijn
AU - Haveman, Jan Willem
AU - DePrizio, Marco
AU - Sabino, Flávio
AU - Viola, Massimo
AU - Berlth, Felix
AU - Grimminger, Peter Philip
AU - Roviello, Franco
AU - van Hillegersberg, Richard
AU - Ruurda, Jelle
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - OBJECTIVE: To gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry.BACKGROUND: The techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature.METHODS: Prospectively registered RAMIG cases for gastric cancer (≥10 per center) were extracted from 25 centers in Europe, Asia, and South-America. Techniques for resection, reconstruction, anastomosis, and lymphadenectomy were analyzed and related to perioperative surgical and oncological outcomes. Complications were uniformly defined by the Gastrectomy Complications Consensus Group.RESULTS: Between 2020 and 2023, 759 patients underwent total (n=272), distal (n=465), or proximal (n=22) gastrectomy (RAMIG). After total gastrectomy with Roux-en-Y-reconstruction, anastomotic leakage rates were 8% with hand-sewn (n=9/111) and 6% with linear stapled anastomoses (n=6/100). After distal gastrectomy with Roux-en-Y (67%) or Billroth-II-reconstruction (31%), anastomotic leakage rates were 3% with linear stapled (n=11/433) and 0% with hand-sewn anastomoses (n=0/26). Extent of lymphadenectomy consisted of D1+ (28%), D2 (59%), or D2+ (12%). Median nodal harvest yielded 31 nodes (interquartile range: 21-47) after total and 34 nodes (interquartile range: 24-47) after distal gastrectomy. R0 resection rates were 93% after total and 96% distal gastrectomy. The hospital stay was 9 days after total and distal gastrectomy, and was median 3 days shorter without perianastomotic drains versus routine drain placement. Postoperative 30-day mortality was 1%.CONCLUSIONS: This large multicenter study provided a worldwide overview of current RAMIG techniques and their respective perioperative outcomes. These outcomes demonstrated high surgical quality, set a quality standard for RAMIG, and can be considered an international reference for surgical standardization.
AB - OBJECTIVE: To gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry.BACKGROUND: The techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature.METHODS: Prospectively registered RAMIG cases for gastric cancer (≥10 per center) were extracted from 25 centers in Europe, Asia, and South-America. Techniques for resection, reconstruction, anastomosis, and lymphadenectomy were analyzed and related to perioperative surgical and oncological outcomes. Complications were uniformly defined by the Gastrectomy Complications Consensus Group.RESULTS: Between 2020 and 2023, 759 patients underwent total (n=272), distal (n=465), or proximal (n=22) gastrectomy (RAMIG). After total gastrectomy with Roux-en-Y-reconstruction, anastomotic leakage rates were 8% with hand-sewn (n=9/111) and 6% with linear stapled anastomoses (n=6/100). After distal gastrectomy with Roux-en-Y (67%) or Billroth-II-reconstruction (31%), anastomotic leakage rates were 3% with linear stapled (n=11/433) and 0% with hand-sewn anastomoses (n=0/26). Extent of lymphadenectomy consisted of D1+ (28%), D2 (59%), or D2+ (12%). Median nodal harvest yielded 31 nodes (interquartile range: 21-47) after total and 34 nodes (interquartile range: 24-47) after distal gastrectomy. R0 resection rates were 93% after total and 96% distal gastrectomy. The hospital stay was 9 days after total and distal gastrectomy, and was median 3 days shorter without perianastomotic drains versus routine drain placement. Postoperative 30-day mortality was 1%.CONCLUSIONS: This large multicenter study provided a worldwide overview of current RAMIG techniques and their respective perioperative outcomes. These outcomes demonstrated high surgical quality, set a quality standard for RAMIG, and can be considered an international reference for surgical standardization.
KW - gastric cancer
KW - minimally invasive gastrectomy
KW - robot-assisted gastrectomy
KW - standardization
UR - https://www.scopus.com/pages/publications/85192722807
U2 - 10.1097/SLA.0000000000006147
DO - 10.1097/SLA.0000000000006147
M3 - Article
C2 - 37922237
SN - 0003-4932
VL - 280
SP - 98
EP - 107
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -