Comparison of short- and long-term outcomes of robotic versus laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant immunochemotherapy: a single-center propensity score matched study.

Neoadjuvant immunochemotherapy (NAIC) has been confirmed to achieve greater tumor regression and better potential survival benefits than neoadjuvant chemotherapy alone. However, for locally advanced gastric cancer after NAIC, existing evidence comparing robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) remains limited. This research included 305 patients in total, among which 196 underwent LG and 109 underwent RG. After propensity score matching (PSM), 90 patients were retained in each cohort. Compared with LG, RG was associated with shorter operative duration (205.49 ± 48.49 min versus 243.27 ± 66.42 min, P < 0.001), higher total number of harvested lymph nodes (31.78 ± 12.86 versus 26.83 ± 10.71, P = 0.006), lower intraoperative blood loss (median: 20 ml versus 30 ml, P = 0.004), and lower incidence of postoperative complications (18.89% versus 37.78%, P = 0.005). Regarding survival outcomes, RG significantly improved the 3-year disease-free survival (DFS) rate (81.1% versus 66.6%, P = 0.029), while no statistically significant between-group difference was observed in 3-year overall survival (OS) (91.1% versus 83.3%, P = 0.136). In conclusion, compared with LG, RG shows clear advantages in short-term postoperative outcomes and 3-year DFS, with no significant difference in 3-year OS.