Robot-assisted versus laparoscopic total gastrectomy: a western high-volume tertiary referral center experience

Robot-assisted gastrectomy has been increasingly adopted as a standard of care, but comparative evidence in Western cohorts remains limited, particularly for total gastrectomy, where esophagojejunostomy and D2 lymphadenectomy are technically demanding. The aim of this study was to compare short-term outcomes after robot-assisted and laparoscopic total gastrectomy at a European high-volume tertiary referral center. This retrospective single-center cohort study included all patients undergoing minimally invasive total gastrectomy (laparoscopic or robot-assisted) for gastric cancer or prophylaxis in CDH1-mutated patients at Karolinska University Hospital (Stockholm, Sweden) from 1 January 2015 to 31 August 2025. The primary outcome was any postoperative complication within 30 days. Secondary outcomes included anastomotic leak, intraoperative blood loss, severe complications (Clavien-Dindo grade ≥ 3), length of stay (LOS), lymph node yield, and 90-day mortality. In total, 156 patients were included (robot-assisted, n=58; laparoscopic, n=98). Any complication occurred in 37.9% after robot-assisted surgery and 68.4% after laparoscopic surgery (P<0.001). Anastomotic leak occurred in 10.3% and 6.1%, respectively (P=0.364). Median blood loss was lower with robot-assisted surgery (50 vs 125 mL, P<0.001). Median LOS, lymph node yield, and 90-day mortality were comparable between groups. In multivariable analyses, robot-assisted surgery was associated with significantly lower odds of any complication (adjusted OR 0.22, 95% CI 0.08-0.56; P = 0.002). There were no statistically significant differences between groups regarding anastomotic leak (adjusted OR 0.73, 95% CI 0.10-5.54; P = 0.761) or severe complications (adjusted OR 0.95, 95% CI 0.32-2.87; P = 0.933). In this Western single-center cohort from a high-volume tertiary referral center, robot-assisted total gastrectomy demonstrated reduced postoperative morbidity to laparoscopic surgery and was associated with reduced intraoperative blood loss.