Robotic Esophagectomy Increases Lymph Node Yield in Randomized Trial

A phase 3 randomized trial published in JAMA Surgery compared robot-assisted minimally invasive esophagectomy (RAMIE) with conventional thoracolaparoscopic minimally invasive esophagectomy (MIE) for resectable esophageal or esophagogastric junction adenocarcinoma. Conducted at four high-volume European referral centers between January 2021 and March 2025, the trial randomized 218 patients; 202 underwent transthoracic esophagectomy, with 101 in each group. The primary endpoint was lymph node yield, assessed using a prespecified modified intention-to-treat analysis.

Median lymph node yield was higher with RAMIE than MIE: 36 versus 32 nodes (P = .005). Luminal R0 resection rates were 99.0% and 97.0%, respectively. Postoperative complication rates were similar, and 90-day mortality was 1.0% versus 3.0% (P = .62). There was no difference in survival at 1 year.

The findings demonstrate greater lymph node retrieval with robotic surgery, but do not establish a survival advantage. Lymph node yield is a surrogate for longer-term oncological benefit, and nonsignificant safety differences do not establish equivalence. Applicability outside high-volume centers remains uncertain. The abstract does not explain why 16 randomized patients were excluded from the surgical analysis; full text was unavailable for assessment.