RAMIE Versus MIE for Resectable Esophageal Cancer, a Randomized Controlled Trial (ROBOT-2 Trial). (ROBOT-2)
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ClinicalTrials.gov Identifier: NCT04306458 |
Recruitment Status :
Recruiting
First Posted : March 13, 2020
Last Update Posted : May 17, 2022
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BACKGROUND: For patients with esophageal cancer, radical esophagectomy with 2-field lymphadenectomy is the cornerstone of the multimodality treatment with curative intent. Both, conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE) were shown to be superior compared to open transthoracic esophagectomy considering postoperative complications. However, no randomized comparison was made until now to compare MIE to RAMIE
OBJECTIVES: The objective is to evaluate the extent of lymph node dissection, efficacy, risks, quality of life and cost-effectiveness of RAMIE as an alternative to MIE as treatment for esophageal adenocarcinoma or adenocarcinoma of the gastroesophageal junction..
METHODS: This is an investigator-initiated and investigator-driven multicenter randomized controlled parallel-group, superiority trial. All adult patients (age ≥18 and ≤ 90 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) adenocarcinoma of the intrathoracic esophagus or adenocarcinoma of the gastroesophageal junction with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n=218) are randomized at the outpatient department to either RAMIE (n=109) or MIE (n=109). The primary outcome of this study is the total number of resected lymph nodes according to the TIGER classification for esophageal cancer lymphadenectomy.
CONCLUSION: This is the first randomized controlled trial designed to compare RAMIE to MIE as surgical treatment for resectable adenocarcinoma of the intrathoracic esophagus or adenocarcinoma of the gastroesophageal junction in the Western World. If our hypothesis is proven correct, RAMIE will result in a better lymph node dissection compared to conventional MIE. The study started in September 2019. Follow up will be 5 years. Short term results will be analyzed and published after discharge of the last randomized patient.
Condition or disease | Intervention/treatment | Phase |
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Esophageal Adenocarcinoma | Procedure: Minimally invasive esophagectomy Device: daVinci Xi system | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 218 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Surgical RCT |
Masking: | Single (Outcomes Assessor) |
Masking Description: | Anonymous cases |
Primary Purpose: | Treatment |
Official Title: | Robot-assisted Minimally Invasive Thoraco-laparoscopic Esophagectomy Versus Minimally Invasive Esophagectomy for Resectable Esophageal Cancer, a Randomized Controlled Trial (ROBOT-2 Trial). |
Actual Study Start Date : | January 18, 2021 |
Estimated Primary Completion Date : | May 19, 2023 |
Estimated Study Completion Date : | January 19, 2028 |
Arm | Intervention/treatment |
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Experimental: Robot assisted minimally invasive esophagectomy
Robot assisted minimally invasive esophagectomy
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Procedure: Minimally invasive esophagectomy
Conventional minimally invasive esophagectomy Device: daVinci Xi system robot assisted minimally invasive esophagectomy |
Active Comparator: Minimally invasive esophagectomy
Conventional minimally invasive esophagectomy
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Procedure: Minimally invasive esophagectomy
Conventional minimally invasive esophagectomy |
- Total number of dissected lymph nodes [ Time Frame: Up to 2 weeks postoperatively ]Total number of dissected lymph nodes in the resection specimen according to the TIGER classification
- Postoperative complications [ Time Frame: Operation date till date of discharge until 52 weeks postoperatively ]Postoperative complications and specific complications
- Length of intensive care unit (ICU) and hospital stay [ Time Frame: Operation date till date of discharge until 52 weeks postoperatively ]Days in the ICU and hospital
- In hospital mortality (IHM) [ Time Frame: Hospital admission period up to 90 days postoperatively ]30, 60 and 90 day mortality
- Pathology results [ Time Frame: Up to 2 weeks postoperatively ]Radical resection (R0 and R1)
- Survival [ Time Frame: 5 years postoperatively ]Overall and disease free survival (2,3 and 5 year)
- Operation statistics [ Time Frame: day of operation ]Operating time (thoracic, abdominal and total), blood loss, intraoperative complications
- Postoperative pain [ Time Frame: Before operation (baseline), daily during admission in the first 14 days, postoperatively: 6 weeks, 6 months and yearly post-operatively up to 5 years ]Postoperative pain scores on a visual analogue scale (VAS)
- Cost analysis [ Time Frame: date of operation until 1 year postoperatively ]Cost analysis
- Surgeons fatigue [ Time Frame: Day of operation ]Surgeons fatigue directly after Operation assessed by Psychomotor Vigilance tests (PVT) before and after esophagectomy
- Quality of life after esophagectomy [ Time Frame: Before operation (baseline), at discharge, postoperatively: 6 weeks, 6 months and yearly up to 5 years post-operatively ]Quality of life assessed by questionnaire European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30
- Postoperative Recovery [ Time Frame: 14 days postoperatively ]Dutch discharge criteria (removal of thoracic tubes, no requirement of intravenous fluid resuscitation, tolerance for solid oral intake, the ability to mobilize independently and adequate pain control with oral analgesics)
- Quality of life after esophagectomy [ Time Frame: Before operation (baseline), at discharge, postoperatively: 6 weeks, 6 months and yearly up to 5 years post-operatively ]Quality of life assessed by questionnaire European Organisation for Research and Treatment of Cancer (EORTC OES18)
- Quality of life after esophagectomy [ Time Frame: Before operation (baseline), at discharge, postoperatively: 6 weeks, 6 months and yearly up to 5 years post-operatively ]Quality of life assessed by questionnaire Short Form (SF)-36
- Quality of life after esophagectomy [ Time Frame: Before operation (baseline), at discharge, postoperatively: 6 weeks, 6 months and yearly up to 5 years post-operatively ]Quality of life assessed by questionnaire EuroQol (EQ)-5D
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Ages Eligible for Study: | 18 Years to 90 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Histologically proven adenocarcinoma of the intrathoracic esophagus and gastroesophageal junction (including Siewert I and II)
- Surgically resectable (T1-4a, N0-3, M0)
- Age ≥ 18 and ≤ 90 years
- European Clinical Oncology Group (ECOG) performance status 0,1 or 2
- Written informed consent
Exclusion Criteria:
- Esophageal squamous cell carcinoma
- Carcinoma of the cervical esophagus
- Carcinoma of the gastro-esophageal junction (GEJ) with the main part of the tumor in the gastric cardia (Siewert type III)
- Prior thoracic surgery at the right hemithorax or thoracic trauma
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04306458
Contact: Pieter Christiaan van der Sluis, MD,PhD | +31628880709 | p.c.vandersluis-2@umcutrecht.nl | |
Contact: Evangelos Tagkalos, MD | +4917673865294 | evangelos.tagkalos@unimedizin-mainz.de |
Germany | |
University Medical Center Mainz | Recruiting |
Mainz, Germany, 55131 | |
Contact: Peter P Grimminger, MD +496131177291 peter.grimminger@unimedizin-mainz.de | |
Contact: Evangelos Tagkalos, MD,MHBA +496131177291 evangelos.tagkalos@unimedizin-mainz.de |
Principal Investigator: | Peter Grimminger, MD,PhD | JGU Medizin Mainz, dept. AVTC |
Responsible Party: | Peter Grimminger, Principle investigator, University Medical Center Mainz |
ClinicalTrials.gov Identifier: | NCT04306458 |
Other Study ID Numbers: |
ROBOT2 trial |
First Posted: | March 13, 2020 Key Record Dates |
Last Update Posted: | May 17, 2022 |
Last Verified: | May 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
minimally invasive esophagectomy robot assisted minimally invasive esophagectomy MIE |
RAMIE lymph node dissection lymphadenectomy |
Esophageal Neoplasms Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site |
Head and Neck Neoplasms Digestive System Diseases Esophageal Diseases Gastrointestinal Diseases |