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Multicenter Study
. 2024 Jul 1;280(1):98-107.
doi: 10.1097/SLA.0000000000006147. Epub 2023 Nov 3.

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

Cas de Jongh  1 , Fabio Cianchi  2 , Takahiro Kinoshita  3 , Feike Kingma  1 , Micaela Piccoli  4 , Attila Dubecz  5 , Ewout Kouwenhoven  6 , Marc van Det  6 , Tom Mala  7 , Andrea Coratti  8 , Paolo Ubiali  9 , Paul Turner  10 , Pursnani Kish  10 , Felice Borghi  11   12 , Arul Immanuel  13 , Magnus Nilsson  14 , Ioannis Rouvelas  14 , Jens P Hӧlzen  15 , Philippe Rouanet  16 , Olivier Saint-Marc  17 , David Dussart  17 , Alberto Patriti  18 , Francesca Bazzocchi  19 , Boudewijn van Etten  20 , Jan W Haveman  20 , Marco DePrizio  21 , Flávio Sabino  22 , Massimo Viola  23 , Felix Berlth  24 , Peter P Grimminger  24 , Franco Roviello  25 , Richard van Hillegersberg  1 , Jelle Ruurda  1 ; UGIRA Collaborative Group
Collaborators, Affiliations
Multicenter Study

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

Cas de Jongh et al. Ann Surg. .

Abstract

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.

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Conflict of interest statement

J.R.: Consulting or Advisory Role: Intuitive Surgical. R.v.H.: Consulting or Advisory Role: Intuitive Surgical, Medtronic. T.K.: honorarium for lectures for Intuitive Surgical, Medtronic, Johnson & Johnson, and Olympus. E.K.: Consulting or Advisory Role: Intuitive Surgical. M.v.D.: Consulting or Advisory Role: Intuitive Surgical. J.P.H.: Consulting or Advisory Role: Intuitive Surgical. P.R.: Consulting or Advisory Role: Intuitive Surgical. O.S.-M.: Consulting or Advisory Role: Intuitive Surgical. The remaining authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study flow chart.
See this image and copyright information in PMC

References

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