The Impact of Robotics on Benchmarking Criteria for the Surgical Treatment of Esophageal Cancer in Western Centers– An Evaluation Using the IDEAL Framework

IF 7.4 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2026-10-01 DOI:10.1097/sla.0000000000007230

Dolores T. Krauss,Pieter S.L. van der Sluis,Lars M. Schiffmann,Hans A. Schlößer,Hans F. Fuchs,Jelle P. Ruurda,Peter P. Grimminger,Richard van Hillegersberg,Christiane J. Bruns

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引用次数: 0

Abstract

Objective/Background: Robotic-assisted minimally invasive esophagectomy (RAMIE) has significantly improved the quality of surgery, reflecting in better functional outcomes, faster recovery, less postoperative morbidity, and even improved oncological results in patients with locally advanced cancer of the esophagus compared with an open approach. Methods: The IDEAL (idea, development, exploration, assessment, long-term study) Framework provides a structured, staged approach to evaluating surgical innovations. Results: The Stage 1 studies describe the introduction of this technique published in 2003 and 2006 (Horgan et al, van Hillegersberg et al) as a proof of concept already showing an acceptable benchmarking for early implementation (48% pulmonary complication rate, 5% mortality). The Stage 2 Exploration phase followed, showing oncological long-term follow-up with 48% 5-year survival rates. The Stage 3 trials (ie, ROBOT Trial) have proven RAMIE to not only be equivalent, but significantly superior for overall complications, pain scores, and quality of life compared with an open approach. Long-term follow-up revealed no differences in survival, making RAMIE oncologically equivalent at a minimum. The Stage 4 evaluation phase started in 2017 with the foundation of the Upper GI International Robotic Association (UGIRA) global registry, which as of November 2025 has 58 contributing sites worldwide and collected 5567 RAMIE cases. With textbook outcome of 41-61%, contemporary leak rates of 11-16% in the most recent UGIRA cohort depending on technique and mortality <4%, RAMIE was safely implemented and is increasingly becoming the primary technique of choice at high-volume tertiary centers. Conclusion: The foundation of the international UGIRA registry has provided compelling evidence regarding standardized training pathways and guidelines and already serves as a scientific template for future technical evolution in upper GI surgery.

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机器人技术对西方中心食管癌手术治疗基准标准的影响-使用IDEAL框架的评估

目的/背景：与开放入路相比，机器人辅助微创食管切除术（RAMIE）显著提高了手术质量，表现为更好的功能结局、更快的恢复速度、更低的术后发病率，甚至改善了局部晚期食管癌患者的肿瘤学结果。方法：IDEAL（构想、发展、探索、评估、长期研究）框架提供了一种结构化的、分阶段的方法来评估外科创新。结果：2003年和2006年发表的第一阶段研究（Horgan等人，van Hillegersberg等人）将该技术的引入描述为概念证明，已经显示出早期实施可接受的基准（48%的肺部并发症发生率，5%的死亡率）。随后是2期探索阶段，肿瘤长期随访，5年生存率为48%。3期试验（即ROBOT试验）证明RAMIE不仅与开放入路相当，而且在总体并发症、疼痛评分和生活质量方面明显优于开放入路。长期随访显示生存率无差异，表明RAMIE在肿瘤上至少是等效的。第四阶段评估阶段始于2017年，当时上GI国际机器人协会（UGIRA）全球注册中心成立，截至2025年11月，该注册中心在全球拥有58个贡献站点，并收集了5567例RAMIE病例。在最近的UGIRA队列中，根据技术的不同，其教科书结果为41-61%，当代泄漏率为11-16%，死亡率为4%，RAMIE安全实施，并日益成为高容量三级中心的首选技术。结论：国际UGIRA注册表的建立为标准化培训途径和指南提供了令人信服的证据，并已成为未来上消化道手术技术发展的科学模板。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.