Surgical Techniques and Related Perioperative Outcomes After Robot-assisted Minimally Invasive Gastrectomy (RAMIG): Results From the Prospective Multicenter International Ugira Gastric Registry

• Published in: Annals of surgery Vol. 280; no. 1; p. 98
• Main Authors: de Jongh, Cas, Cianchi, Fabio, Kinoshita, Takahiro, Kingma, Feike, Piccoli, Micaela, Dubecz, Attila, Kouwenhoven, Ewout, van Det, Marc, Mala, Tom, Coratti, Andrea, Ubiali, Paolo, Turner, Paul, Kish, Pursnani, Borghi, Felice, Immanuel, Arul, Nilsson, Magnus, Rouvelas, Ioannis, Hӧlzen, Jens P, Rouanet, Philippe, Saint-Marc, Olivier, Dussart, David, Patriti, Alberto, Bazzocchi, Francesca, van Etten, Boudewijn, Haveman, Jan W, DePrizio, Marco, Sabino, Flávio, Viola, Massimo, Berlth, Felix, Grimminger, Peter P, Roviello, Franco, van Hillegersberg, Richard, Ruurda, Jelle
• Format: Journal Article
• Language: English
• Published: United States 01.07.2024
• Subjects: Aged; Female; Gastrectomy - methods; Humans; Lymph Node Excision - methods; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Postoperative Complications - epidemiology; Prospective Studies; Registries; Robotic Surgical Procedures; Stomach Neoplasms - surgery; Treatment Outcome
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000006147

To gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry. The techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature. 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. 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%. 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.