Current Status and Future Perspectives of Robotic Surgery for Esophagogastric Cancer in Asia

Robotic-assisted surgery (RAS) has moved from an experimental adjunct to an increasingly established component of gastrointestinal (GI) oncological practice in parts of Asia, a region that carries a disproportionately high burden of gastric and esophageal cancer. Asian surgeons have been among the earliest and most prolific contributors to the clinical evidence base for robotic gastrectomy and robot-assisted minimally invasive esophagectomy. This narrative review synthesizes evidence from randomized trials (including the ROBOT, RAMIE, and REVATE trials, and the ongoing MONA LISA [JCOG1907] study), multicenter prospective and propensity-matched cohort studies, and recent meta-analyses to critically appraise the efficacy, safety, cost, and future trajectory of RAS in Asia. Across multiple Korean, Japanese, and Chinese series, RG and RAMIE are associated with reduced short-term morbidity, improved lymph node retrieval in technically demanding anatomic regions, and lower rates of recurrent laryngeal nerve injury compared with conventional laparoscopic or thoracoscopic approaches; however, much of the evidence on long-term oncological outcomes remains retrospective or derived from propensity-score analyses rather than mature randomized data, and results across studies are not always concordant. We argue that robotic surgery in Asia is best understood as passing through three overlapping transitions: technical and oncological validation, economic and educational democratization, and digital and telesurgical integration, each of which carries distinct and unresolved questions. We conclude that while RAS has demonstrably reshaped upper GI surgical practice in high-volume Asian centers, its designation as a definitive regional standard of care should await longer-term randomized outcomes, standardized credentialing, and more equitable deployment across the region.