Related Experiment Video
Updated: Sep 3, 2026
Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer
Published on: October 31, 2025
Operative safety and oncologic outcomes of robotic and laparoscopic total gastrectomy for advanced middle-upper
Hua-Long Zheng1,2, Hong-Hong Zheng1,2, Tai-Yuan Li3
1Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Background:
Robotic total gastrectomy (RTG) has been proposed as a promising alternative to laparoscopic total gastrectomy (LTG) for advanced middle-upper gastric cancer (AMUGC) due to its potential to overcome anatomical challenges. However, the comparative evidence regarding both safety and long-term oncologic efficacy remains limited.
Methods:
This retrospective cohort study included 1099 patients with AMUGC who underwent RTG/LTG at eight high-volume centers in China between 2015 and 2019. Propensity score matching (PSM = 1:1) was used to balance clinicopathological characteristics between the two groups. The primary outcome was 3-year disease-free survival (DFS); secondary outcomes included 3-year overall survival (OS), 3-year cumulative incidence of recurrence (CIR), recurrence patterns, and operative outcomes.
Results:
In the PSM cohort, 229 patients were included in each group. RTG demonstrated lower overall postoperative complications (16.2% vs. 27.1%, P < 0.05), medical complications (6.6% vs. 17.0%, P < 0.05), and pneumonia rates (6.6% vs. 16.2%, P < 0.05). No differences were observed in 3-year DFS (73.7% vs. 68.1%, P = 0.230), 3-year OS (76.8% vs. 72.4%, P = 0.326), CIR (24.4% vs. 26.8%, P = 0.580), and recurrence patterns. In stage III, 3-year DFS was higher in the RTG group (67.4% vs. 54.5%, P = 0.047), but no significant differences were found in 3-year OS or CIR (all P > 0.05). Multivariate analysis confirmed that the surgical method was not significantly associated with 3-year DFS [hazard ratio (HR), 0.767; 95% confidence interval (CI), 0.542-1.086; P = 0.135] or 3-year OS (HR, 0.774; 95% CI, 0.534-1.122; P = 0.177).
Conclusions:
For AMUGC patients not receiving neoadjuvant chemotherapy, RTG demonstrated potential advantages in certain operative outcomes and non-inferior 3-year oncological outcomes compared with LTG. Prospective trials are needed to validate these findings.
