Discussion
In this study of patients undergoing robot-assisted oesophageal and gastric resection at Oslo University Hospital, the incidence of anastomotic leakage, 90-day mortality and reoperation was within the national standards defined by the target levels set by NORGAST. Unlike the NORGAST annual report, this study presents exclusively the outcomes of patients operated on using a robot-assisted technique and represents the total institutional experience since robot-assisted procedures were established in 2018 (5). NORGAST's annual reports show that the proportion of robot-assisted procedures nationally for the oesophagus and abdomen, for both benign and malignant diseases, was 38.1 % and 17.4 % in 2022, and 67.7 % and 34.2 % in 2024, respectively (5, 9). Large-scale international multicentre studies report anastomotic leakage in approximately 20 % of robot-assisted oesophageal resections and 5 % of robot-assisted gastric resections (4, 10). The reoperation rate after gastric resection is reported to be around 7 % (10). Reported 90-day mortality is approximately 4 % for robot-assisted oesophageal resection and 5 % for robot-assisted gastric resection (11, 12). Our observations, which encompass the introduction of robot-assisted surgery, are therefore consistent with the outcomes reported by leading international centres.
Oslo University Hospital is one of four centres performing surgery for oesophageal or gastric cancer in Norway. During the study period, we performed approximately 60 oesophageal resections and 30 gastric resections annually. Prior to the introduction of robot-assisted surgery, operations were performed using minimally invasive techniques, specifically thoracolaparoscopic oesophageal resection from 2013 and laparoscopic gastric resection from 2015.
In April 2025, the Decision Forum (a governmental body responsible for approving new diagnostic and treatment methods in Norway) concluded that the evidence base for the use of robot-assisted surgery was limited. It was recommended that the acquisition of new surgical robots outside university hospitals be restricted to hospitals with sufficient volumes in rectal, prostate and uterine cancer surgery (13). We therefore believe it is particularly important to document outcomes using the technique, with special emphasis on validated quality indicators. We have previously published more detailed articles on the introduction of robot-assisted oesophageal and gastric resection at our department in international peer-reviewed journals (8, 14).
Throughout the study period, the department enlisted a large number of patients in a randomised trial (Kinetic) comparing the use of a nasogastric tube (standard treatment) with no tube (experimental treatment) after oesophageal resection (15). This was the only systematic change in postoperative patient management during the period and may have contributed to a higher incidence of anastomotic leakage than previously, as nasogastric tubes appear to protect against leakage, and there was an increased focus on leakage diagnostics during the study period (14).
The study suggests that robot-assisted oesophageal and gastric resection has been introduced safely at our institution, which has prior experience with minimally invasive surgery for oesophageal and gastric cancer.