Related Experiment Video
Updated: May 12, 2026
Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer
Published on: October 31, 2025
Comparison of long-term outcomes of robotic gastrectomy and laparoscopic gastrectomy using the modified age-adjusted
Kyota Takahashi1, Keiichi Fujiya1, Masanori Terashima2
1Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Background:
The modified age-adjusted Charlson Comorbidity Index (mACCI) is associated with postoperative complications and long-term survival after gastrectomy. However, whether robotic gastrectomy (RG) provides clinical advantages over laparoscopic gastrectomy (LG) in high-risk patients remains unclear. This study evaluated short- and long-term outcomes of RG compared with LG according to mACCI.
Methods:
A total of 1501 patients who underwent minimally invasive gastrectomy for clinical stage I-II gastric cancer between 2012 and 2021 were retrospectively analyzed. Patients were stratified by mACCI (< 4 and ≥ 4), and propensity score matching was performed within each stratum. Short-term outcomes, overall survival (OS), recurrence-free survival (RFS), and cumulative incidence of other-cause and gastric cancer-specific death were assessed.
Results:
Among patients with mACCI ≥ 4, RG was associated with a lower incidence of postoperative complications than LG after matching (2.7% vs. 8.2%, P = 0.036), including pancreatic fistula (0% vs. 3.3%, P = 0.030). RG showed significantly improved OS (HR 0.485, 95% CI 0.271-0.868, P = 0.015) and RFS (HR 0.417, 95% CI 0.236-0.738, P = 0.003). Competing risk analysis demonstrated a lower incidence of other-cause death in the RG group, whereas gastric cancer-specific mortality did not differ. No significant differences were observed between approaches in patients with mACCI < 4.
Conclusions:
Robotic gastrectomy was associated with reduced postoperative complications and improved long-term outcomes in high-risk patients with substantial comorbidities. RG may represent a preferable surgical approach in this population.
