Short-Term Outcomes of Robotic Gastrectomy in Elderly Gastric Cancer Patients: A Propensity Score-Matched Comparison With Robotic Gastrectomy in Non-Elderly Patients and Laparoscopic Gastrectomy in Elderly.

INTRODUCTION

Surgery for gastric cancer in elderly patients is challenging because of comorbidities and diminished physiological reserve. Robotic gastrectomy (RG) may improve outcomes via technical precision; however, its impact on the elderly remains unclear. This study evaluated the short-term outcomes of RG between elderly and non-elderly patients, and between RG and laparoscopic gastrectomy (LG) in elderly patients using propensity score matching (PSM).

METHODS

We retrospectively analyzed elderly patients who underwent RG or LG and non-elderly patients who underwent RG for gastric cancer between April 2020 and December 2024. Patients were divided into elderly RG (≥ 80 years, n = 33), non-elderly RG (< 80 years, n = 118), and elderly LG groups (n = 46). PSM (1:1) adjusted between elderly and non-elderly RG groups, and between elderly RG and LG groups. Short-term surgical outcomes and postoperative complications were compared.

RESULTS

After PSM, there was no significant difference in surgical complication rates (16% vs. 6%; p = 0.43) between elderly and non-elderly RG groups. However, the elderly group had numerically higher non-surgical complications (12% vs. 3%; p = 0.35), primarily driven by non-surgical issues, such as acute heart failure, atelectasis, and urinary tract infections. Postoperative complication rates were also similar between elderly RG and LG groups.

CONCLUSION

RG appears to be a safe and feasible procedure for elderly patients aged ≥ 80 years, providing surgical stability comparable to that in younger and elderly patients who underwent LG. While the robotic platform may contribute to mitigating surgery-related risks, the higher incidence of non-surgical complications underscores the necessity of tailored perioperative management addressing elderly-specific vulnerabilities in this population.