Robotic esophagectomy (RAMIE) offers its greatest advantage in esophageal cancer — where the narrow mediastinum, recurrent laryngeal nerve preservation, and complex anastomosis make robotic precision not just beneficial, but transformative. Dr. Vinod T. Gore performs RAMIE for both SCC and Adenocarcinoma of the esophagus.
Esophageal cancer is not one disease — it is two biologically and clinically distinct cancers that happen to arise in the same organ. Treatment strategy, chemotherapy protocol, and surgical approach differ significantly between them.
Progressive difficulty swallowing is the hallmark symptom of esophageal cancer. It is never normal and must be investigated immediately. By the time dysphagia develops, the tumour is often obstructing over 50% of the esophageal lumen.
Full staging requires CT chest/abdomen/pelvis, PET-CT (essential — identifies occult distant metastases in up to 15% of cases), and Endoscopic Ultrasound (EUS) for precise T and N staging.
| Stage | Classification | Description & Approach | 5-yr Survival |
|---|---|---|---|
Stage I | T1, N0, M0 | Tumour confined to mucosa or submucosa. Endoscopic resection (ESD/EMR) for T1a. Surgical esophagectomy for T1b with unfavourable features. | 75–90% |
Stage II | T2–T3, N0–N1 | Tumour into muscle layer or beyond, with limited nodal spread. CROSS chemoradiation followed by esophagectomy is standard. | 35–55% |
Stage III | T3–T4a, N1–N3 | Locally advanced. CROSS (SCC/ACA) or FLOT (ACA) neoadjuvant therapy followed by esophagectomy. Aim for complete R0 resection. | 15–35% |
Stage IV | Any T, Any N, M1 | Distant metastases. Systemic chemotherapy ± immunotherapy (pembrolizumab for PD-L1+). Surgery palliative only. | <10% |
Every resectable esophageal cancer follows a structured neoadjuvant pathway — CROSS or FLOT chemotherapy before surgery, followed by RAMIE and adjuvant therapy. Every decision is made at the MDT tumour board.
The choice of esophagectomy depends on the tumour location, histological type (SCC vs ACA), and patient fitness. All approaches are performed using robotic (RAMIE) or minimally invasive technique wherever possible.
RAMIE combines a thoracoscopic phase (in the chest) with a laparoscopic phase (in the abdomen) — both performed using the da Vinci Xi robotic system. The esophagus is removed with complete mediastinal lymphadenectomy, and a gastric conduit is fashioned from the stomach. Dr. Gore performs RAMIE as his primary approach for all eligible esophageal cancer patients.
After the esophagus is removed, the digestive tract must be reconstructed to restore the ability to eat. The stomach (as a gastric conduit) is used in over 90% of cases. ICG fluorescence is used to confirm conduit blood supply before the anastomosis.
Bring your CT scan, PET-CT, endoscopy report, EUS result, and biopsy with HER2 report. Dr. Gore will review everything at the first consultation and outline the full treatment plan — CROSS or FLOT, RAMIE, and adjuvant therapy.