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 - UGIRA Collaborative Group
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
A2 - Giulini, Luca
N1 - Dubecz: Klinikum Nürnberg, Department of Surgery, Paracelsus Medical University, Nürnberg, Germany; Giulini (study gr member): Klinikum Nürnberg, Department of Surgery, Paracelsus Medical University, Nürnberg, Germany
PY - 2023/11/3
Y1 - 2023/11/3
N2 - OBJECTIVE: To gain insight in global practice of RAMIG and evaluated perioperative outcomes using an international registry.BACKGROUND: The techniques and perioperative outcomes of robot-assisted minimally invasive gastrectomy (RAMIG) for gastric cancer vary substantially in 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 the 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 2020-2023, 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 [IQR 21-47] after total and 34 nodes [IQR 24-47] after distal gastrectomy. R0-resection rates were 93% after total and 96% distal gastrectomy. Hospital stay was 9 days after total and distal gastrectomy, and was 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 with 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 in global practice of RAMIG and evaluated perioperative outcomes using an international registry.BACKGROUND: The techniques and perioperative outcomes of robot-assisted minimally invasive gastrectomy (RAMIG) for gastric cancer vary substantially in 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 the 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 2020-2023, 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 [IQR 21-47] after total and 34 nodes [IQR 24-47] after distal gastrectomy. R0-resection rates were 93% after total and 96% distal gastrectomy. Hospital stay was 9 days after total and distal gastrectomy, and was 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 with 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.
U2 - 10.1097/SLA.0000000000006147
DO - 10.1097/SLA.0000000000006147
M3 - Original Article (Journal)
C2 - 37922237
SN - 0003-4932
JO - ANNALS OF SURGERY
JF - ANNALS OF SURGERY
ER -