According to results from the phase III ROBOT-2 trial published in JAMA Surgery, robot-assisted minimally invasive esophagectomy provided a more radical lymphadenectomy than conventional minimally invasive esophagectomy in patients with esophageal or esophagogastric junction adenocarcinoma. Berlth et al additionally reported similar surgical safety and survival at 1 year between the approaches.
“These results support the use of robotic esophagectomy as a standard approach…,” the investigators wrote.
Study Details
The multicenter trial was conducted between January 2021 and March 2025 at four high-volume tertiary referral centers in Germany, the Netherlands, and Switzerland, and included patients with resectable adenocarcinoma of the esophagus or esophagogastric junction. Eligible patients had cT1 to cT4a, cN0 to cN3, and cM0 disease; were scheduled for thoracoabdominal esophagectomy; and could undergo either primary surgery or multimodal treatment.
A total of 218 patients were randomly assigned 1:1 to undergo robot-assisted minimally invasive esophagectomy or conventional minimally invasive esophagectomy; 202 ultimately underwent surgery, with 101 in each arm (mean age = 64.8 years; 89.6% male). Follow-up was planned for up to 5 years.
The prespecified primary endpoint was the number of resected lymph nodes, analyzed in the modified intention-to-treat population. Secondary endpoints included luminal R0 resection (defined as negative microscopic margins), postoperative complications, 90-day mortality, and 1-year survival.
Key Findings
Robot-assisted minimally invasive esophagectomy was found to be associated with a significantly higher median number of resected lymph nodes than conventional minimally invasive esophagectomy (36 vs 32 nodes; P = .005). The luminal R0 resection rates were 99% and 97%, respectively (P = .62).
Postoperative complication rates were similar with robot-assisted minimally invasive esophagectomy and conventional minimally invasive esophagectomy (53.5% vs 47.5%; P = .40), as were 90-day mortality rates (1.0% vs 3.0%; P = .62).
At 1 year, estimated overall survival was 80.8% with robot-assisted minimally invasive esophagectomy and 84.3% with conventional minimally invasive esophagectomy (P = .49).
“Taken together, the present evidence, the optimal oncologic esophagectomy for adenocarcinoma should involve minimally invasive techniques, lead to a high lymph node yield and R0 resection rate, and [result in] low postoperative morbidity,” the investigators concluded. “The presented results support use of the robotic platform for oncologic esophagectomy in respect of both safety and lymphadenectomy.”
Peter P. Grimminger, MD, of University Medical Center of the Johannes Gutenberg University Mainz, Germany, is the corresponding author of the article in JAMA Surgery.
Disclosure: The study was supported in part by Intuitive Surgical. For full disclosures of the study authors, visit jamanetwork.com.
