{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:04:13Z","timestamp":1794488653797,"version":"4.9.1"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomly assigned (1:1) to RAMIE or conventional MIE.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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;\n P<\/jats:italic>\n \u2009=\u2009.005). 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 (\n P<\/jats:italic>\n \u2009=\u2009.62). There was no difference in survival after 1 year.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04306458<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.4478","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:31:41Z","timestamp":1790782301000},"page":"1135","source":"Crossref","is-referenced-by-count":1,"title":["Robotic vs Thoracolaparoscopic Esophagectomy for Esophageal Cancer"],"prefix":"10.1001","volume":"161","author":[{"given":"Felix","family":"Berlth","sequence":"first","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne S.","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Goense","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht, University of Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Schiesser","sequence":"additional","affiliation":[{"name":"Esophageal Cancer Center and Digestive Oncology Tumor Center, Hirslanden Medical Center, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Bruns","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hauke","family":"Lang","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 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