Robotic vs Thoracolaparoscopic Esophagectomy for Esophageal Cancer
Felix Berlth, Suzanne S. Gisbertz, Evangelos Tagkalos, Edin Hadzijusufovic, Paul Magnus Schneider, Hans Fuchs, Mark I. van Berge Henegouwen, Vladimir J. Lozanovski, Jelle P. Ruurda, Lucas Goense, Marc Schiesser, Christiane Bruns, Hauke Lang, Richard van Hillegersberg, Peter P. GrimmingerImportance
The optimal surgical approach for oncological thoracoabdominal esophagectomy for adenocarcinoma is unclear. Robot-assisted minimally invasive esophagectomy (RAMIE) may facilitate a more extensive lymphadenectomy compared with conventional minimally invasive esophagectomy (MIE), which is crucial to achieve a favorable oncological outcome.
Objective
To determine whether RAMIE results in a higher yield of resected lymph nodes compared with conventional MIE in patients undergoing surgery for esophageal or esophagogastric junction adenocarcinoma.
Design, Setting, and Participants
This was a phase 3 randomized clinical trial conducted between January 2021 and March 2025 at 4 high-volume tertiary referral centers in Mainz, Germany; Amsterdam, the Netherlands; Zurich, Switzerland; and Cologne, Germany. Patients with resectable adenocarcinoma of the esophagus or esophagogastric junction staged as cT1-4a, cN0-3, and cM0 were included. Both primary surgery and multimodal treatment settings were eligible. A total of 218 patients were initially randomized, 202 of whom completed the study and underwent transthoracic esophagectomy with follow-up up to 5 years.
Interventions
Participants were randomly assigned (1:1) to RAMIE or conventional MIE.
Main Outcomes and Measures
The primary end point was the number of resected lymph nodes, planned a priori and analyzed on a modified intention-to-treat basis. Secondary measures included luminal R0 resection rates, postoperative complication rates, 90-day mortality, and 1-year survival.
Results
Between 2021 and 2025, 218 patients were included in the study, 202 of whom (mean [SD] age, 64.8 [10.1] years; 181 [89.6%] male) underwent transthoracic esophagectomy (101 RAMIE and 101 MIE). The median number of resected lymph nodes was significantly higher in RAMIE compared to MIE (36 vs 32; P = .005). Luminal R0 resection was 99.0% with RAMIE and 97.0% with MIE. Rates of postoperative complications were similar between groups; 90-day mortality was 1.0% in the RAMIE group and 3.0% in the MIE group ( P = .62). There was no difference in survival after 1 year.
Conclusions and Relevance
In this study, robotic esophagectomy provided a more radical lymphadenectomy compared to conventional minimally invasive esophagectomy with equal results for surgical safety. These results support the use of robotic esophagectomy as a standard approach for adenocarcinoma of the esophagus or esophagogastric junction.
Trial Registration
ClinicalTrials.gov Identifier: