• Cas de Jongh, Fabio Cianchi, Takahiro Kinoshita, Feike Kingma, Micaela Piccoli, Attila Dubecz, Ewout Kouwenhoven, Marc van Det, Tom Mala, Andrea Coratti, Paolo Ubiali, Paul Turner, Pursnani Kish, Felice Borghi, Arul Immanuel, Magnus Nilsson, Ioannis Rouvelas, Jens P Hӧlzen, Philippe Rouanet, Olivier Saint-Marc, David Dussart, Alberto Patriti, Francesca Bazzocchi, Boudewijn van Etten, Jan W Haveman, Marco DePrizio, Flávio Sabino, Massimo Viola, Felix Berlth, Peter P Grimminger, Franco Roviello, Richard van Hillegersberg, Jelle Ruurda, and UGIRA Collaborative Group.
• Department of Surgery, University Medical Center (UMC) Utrecht, University of Utrecht, Utrecht, The Netherlands.
• Ann. Surg. 2024 Jul 1; 280 (1): 9810798-107.

ObjectiveTo gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry.BackgroundThe techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature.MethodsProspectively 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.ResultsBetween 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%.ConclusionsThis 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.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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