Comparison of robotic and laparoscopic gastrectomy using textbook oncologic outcome: a matched cohort study

By evaluating whether a patient simultaneously satisfies multiple desirable goals, textbook oncologic outcome (TOO) offers a composite assessment of cancer-surgery quality. This study investigated whether TOO attainment after curative gastric cancer surgery differed according to the operative approach. We retrospectively reviewed 945 patients with gastric adenocarcinoma who received curative-intent robotic gastrectomy (RG; n = 161) or laparoscopic gastrectomy (LG; n = 784) between 2017 and 2025. Propensity score matching yielded 147 patients in each group. When each of the following was recorded, a TOO was attained: margin-negative resection, assessment of at least 15 lymph nodes, survival beyond 30 postoperative days, hospital discharge no later than postoperative day 7, and guideline-appropriate adjuvant chemotherapy. We compared operative characteristics, postoperative recovery, complications, and survival between the approaches. Among matched patients, the complete TOO was attained after 66.0% of RG procedures and 43.5% of LG procedures (P < 0.001). Although RG had a longer operating time, it was linked to quicker gastrointestinal healing and discharge as well as decreased blood loss. The between-group difference in the composite measure was driven chiefly by discharge within 7 days. Overall and major complication rates did not differ significantly. Multivariable analysis identified RG (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.52-4.07; P < 0.001) and distal gastrectomy (OR, 3.32; 95% CI, 1.46-7.56; P = 0.004) as positive correlates of TOO attainment, whereas estimated blood loss of at least 50 mL was a negative correlate (OR, 0.37; 95% CI, 0.21-0.67; P = 0.001). The approaches showed no significant difference in estimated 5-year overall or disease-free survival. Patients undergoing RG met all five TOO criteria more frequently, largely because they were more likely to leave the hospital by postoperative day 7 rather than because of differences in oncologic radicality. RG was also associated with lower blood loss and faster early recovery, while morbidity and survival were comparable between approaches. These findings should be interpreted as reflecting an advantage of RG in postoperative recovery and length of stay rather than demonstrable superiority in overall oncologic or surgical quality.