The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry

Cezanne D Kooij; Cas de Jongh; B Feike Kingma; Mark I van Berge Henegouwen; Suzanne S Gisbertz; Yin-Kai Chao; Philip W Chiu; Philippe Rouanet; Anne Mourregot; Arul Immanuel; Tom Mala; Gijs I van Boxel; Nicholas C Carter; Hecheng Li; Hans F Fuchs; Christiane J Bruns; Simone Giacopuzzi; Jörg C Kalff; Jens-Peter Hölzen; Mazen A Juratli; Frank Benedix; Eric Lorenz; Jan-Hendrik Egberts; Jan W Haveman; Boudewijn van Etten; Beat P Müller; Peter P Grimminger; Felix Berlth; Guillaume Piessen; Jan W van den Berg; Marco Milone; James D Luketich; Inderpal S Sarkaria; Rubens A A Sallum; Marc J van Det; Ewout A Kouwenhoven; Matthias Brüwer; Tomas Harustiak; Takahiro Kinoshita; Takeo Fujita; Hiroyuki Daiko; Zhigang Li; Jelle P Ruurda; Richard van Hillegersberg

doi:10.1245/s10434-024-16364-9

The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry

Cezanne D Kooij, Cas de Jongh, B Feike Kingma, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Yin-Kai Chao, Philip W Chiu, Philippe Rouanet, Anne Mourregot, Arul Immanuel, Tom Mala, Gijs I van Boxel, Nicholas C Carter, Hecheng Li, Hans F Fuchs, Christiane J Bruns, Simone Giacopuzzi, Jörg C Kalff, Jens-Peter Hölzen, Mazen A JuratliFrank Benedix, Eric Lorenz, Jan-Hendrik Egberts, Jan W Haveman, Boudewijn van Etten, Beat P Müller, Peter P Grimminger, Felix Berlth, Guillaume Piessen, Jan W van den Berg, Marco Milone, James D Luketich, Inderpal S Sarkaria, Rubens A A Sallum, Marc J van Det, Ewout A Kouwenhoven, Matthias Brüwer, Tomas Harustiak, Takahiro Kinoshita, Takeo Fujita, Hiroyuki Daiko, Zhigang Li, Jelle P Ruurda, Richard van Hillegersberg,

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Abstract

BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement.

METHODS: This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases).

RESULTS: Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days.

CONCLUSIONS: This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.

Original language	English
Pages (from-to)	823–833
Number of pages	11
Journal	Annals of surgical oncology
Volume	32
Issue number	2
Early online date	4 Nov 2024
DOIs	https://doi.org/10.1245/s10434-024-16364-9
Publication status	Published - 2025

Keywords

Esophageal cancer
Minimally invasive esophagectomy
Robot-assisted esophagectomy

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Kooij, C. D., de Jongh, C., Kingma, B. F., van Berge Henegouwen, M. I., Gisbertz, S. S., Chao, Y.-K., Chiu, P. W., Rouanet, P., Mourregot, A., Immanuel, A., Mala, T., van Boxel, G. I., Carter, N. C., Li, H., Fuchs, H. F., Bruns, C. J., Giacopuzzi, S., Kalff, J. C., Hölzen, J.-P. (2025). The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry. Annals of surgical oncology, 32(2), 823–833. https://doi.org/10.1245/s10434-024-16364-9

@article{2c13173b54ef47cbac289699ae795502,

title = "The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry",

abstract = "BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement.METHODS: This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases).RESULTS: Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days.CONCLUSIONS: This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.",

keywords = "Esophageal cancer, Minimally invasive esophagectomy, Robot-assisted esophagectomy",

author = "Kooij, {Cezanne D} and {de Jongh}, Cas and Kingma, {B Feike} and {van Berge Henegouwen}, {Mark I} and Gisbertz, {Suzanne S} and Yin-Kai Chao and Chiu, {Philip W} and Philippe Rouanet and Anne Mourregot and Arul Immanuel and Tom Mala and {van Boxel}, {Gijs I} and Carter, {Nicholas C} and Hecheng Li and Fuchs, {Hans F} and Bruns, {Christiane J} and Simone Giacopuzzi and Kalff, {J{\"o}rg C} and Jens-Peter H{\"o}lzen and Juratli, {Mazen A} and Frank Benedix and Eric Lorenz and Jan-Hendrik Egberts and Haveman, {Jan W} and {van Etten}, Boudewijn and M{\"u}ller, {Beat P} and Grimminger, {Peter P} and Felix Berlth and Guillaume Piessen and {van den Berg}, {Jan W} and Marco Milone and Luketich, {James D} and Sarkaria, {Inderpal S} and Sallum, {Rubens A A} and {van Det}, {Marc J} and Kouwenhoven, {Ewout A} and Matthias Br{\"u}wer and Tomas Harustiak and Takahiro Kinoshita and Takeo Fujita and Hiroyuki Daiko and Zhigang Li and Ruurda, {Jelle P} and {van Hillegersberg}, Richard",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2025",

doi = "10.1245/s10434-024-16364-9",

language = "English",

volume = "32",

pages = "823–833",

journal = "Annals of surgical oncology",

issn = "1068-9265",

publisher = "Springer New York",

number = "2",

}

Kooij, CD, de Jongh, C, Kingma, BF, van Berge Henegouwen, MI, Gisbertz, SS, Chao, Y-K, Chiu, PW, Rouanet, P, Mourregot, A, Immanuel, A, Mala, T, van Boxel, GI, Carter, NC, Li, H, Fuchs, HF, Bruns, CJ, Giacopuzzi, S, Kalff, JC, Hölzen, J-P, Juratli, MA, Benedix, F, Lorenz, E, Egberts, J-H, Haveman, JW, van Etten, B, Müller, BP, Grimminger, PP, Berlth, F, Piessen, G, van den Berg, JW, Milone, M, Luketich, JD, Sarkaria, IS, Sallum, RAA, van Det, MJ, Kouwenhoven, EA, Brüwer, M, Harustiak, T, Kinoshita, T, Fujita, T, Daiko, H, Li, Z, Ruurda, JP , van Hillegersberg, R 2025, 'The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry', Annals of surgical oncology, vol. 32, no. 2, pp. 823–833. https://doi.org/10.1245/s10434-024-16364-9

The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry. / Kooij, Cezanne D; de Jongh, Cas; Kingma, B Feike et al.
In: Annals of surgical oncology, Vol. 32, No. 2, 2025, p. 823–833.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE)

T2 - Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry

AU - Kooij, Cezanne D

AU - de Jongh, Cas

AU - Kingma, B Feike

AU - van Berge Henegouwen, Mark I

AU - Gisbertz, Suzanne S

AU - Chao, Yin-Kai

AU - Chiu, Philip W

AU - Rouanet, Philippe

AU - Mourregot, Anne

AU - Immanuel, Arul

AU - Mala, Tom

AU - van Boxel, Gijs I

AU - Carter, Nicholas C

AU - Li, Hecheng

AU - Fuchs, Hans F

AU - Bruns, Christiane J

AU - Giacopuzzi, Simone

AU - Kalff, Jörg C

AU - Hölzen, Jens-Peter

AU - Juratli, Mazen A

AU - Benedix, Frank

AU - Lorenz, Eric

AU - Egberts, Jan-Hendrik

AU - Haveman, Jan W

AU - van Etten, Boudewijn

AU - Müller, Beat P

AU - Grimminger, Peter P

AU - Berlth, Felix

AU - Piessen, Guillaume

AU - van den Berg, Jan W

AU - Milone, Marco

AU - Luketich, James D

AU - Sarkaria, Inderpal S

AU - Sallum, Rubens A A

AU - van Det, Marc J

AU - Kouwenhoven, Ewout A

AU - Brüwer, Matthias

AU - Harustiak, Tomas

AU - Kinoshita, Takahiro

AU - Fujita, Takeo

AU - Daiko, Hiroyuki

AU - Li, Zhigang

AU - Ruurda, Jelle P

AU - van Hillegersberg, Richard

PY - 2025

Y1 - 2025

N2 - BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement.METHODS: This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases).RESULTS: Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days.CONCLUSIONS: This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.

AB - BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement.METHODS: This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases).RESULTS: Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days.CONCLUSIONS: This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.

KW - Esophageal cancer

KW - Minimally invasive esophagectomy

KW - Robot-assisted esophagectomy

UR - http://www.scopus.com/inward/record.url?scp=85208228087&partnerID=8YFLogxK

U2 - 10.1245/s10434-024-16364-9

DO - 10.1245/s10434-024-16364-9

M3 - Article

C2 - 39496901

SN - 1068-9265

VL - 32

SP - 823

EP - 833

JO - Annals of surgical oncology

JF - Annals of surgical oncology

IS - 2

ER -

The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry

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