Assessment of robotic versus laparoscopic gastrectomy for gastric cancer patients with intraoperative technical...

While robotic gastrectomy (RG) is increasingly used in gastric cancer surgery, its potential advantages over laparoscopic gastrectomy (LG) in intraoperative technical complexity (ITC) cases remain debated.

This retrospective cohort study included 3534 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals. ITC was defined by any of the following criteria: operative time exceeding the third quartile, intraoperative estimated blood loss ≥400 mL, or conversion to open surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were conducted to compare short- and long-term outcomes.

Patients with ITC comprised 25.9% (916/3534) of the cohort (RG: 260, LG: 656). After baseline adjustment, RG and LG groups were comparable in both PSM and IPTW cohorts. RG showed lower overall postoperative complications (11.5% vs. 20.1%, P = 0.003), particularly pneumonia (2.3% vs. 11.0%, P < 0.001) and shorter postoperative hospital stay (9.33 ± 4.41 vs. 10.77 ± 5.91 days, P < 0.001) compared to LG. These differences remained significant after PSM and IPTW analysis. The 3-year overall survival (83% vs. 78.8%, P = 0.15), disease-free survival (81.9% vs. 76.2%, P = 0.073), and cumulative recurrence risk (16.9% vs. 20%, P = 0.26) were comparable between RG and LG groups, consistent after PSM and IPTW. Multivariate analysis indicated that the surgical approach was not an independent factor influencing technical complexity.

For patients with ITC, RG demonstrated superior short-term and comparable long-term outcomes than LG.