A retrospective case-control study of Da Vinci robotic versus laparoscopic radical gastrectomy for gastric cancer under an enhanced recovery after surgery protocol.

OBJECTIVE: To compare the safety and short-term efficacy of radical gastrectomy using the Da Vinci fully robotic system versus laparoscopic surgery under a standardised enhanced recovery after surgery (ERAS) protocol, with multivariate adjustment for baseline differences in tumour stage and nutritional status.

METHODS: A retrospective case-control analysis of 259 patients (RTG: n=121; LTG: n=138) undergoing gastric cancer radical surgery at Jiangsu Provincial Hospital of Traditional Chinese Medicine (August 2018-July 2022) under a uniform institutional ERAS protocol. Univariate comparisons were supplemented by multivariate regression analyses adjusting for pathological TNM stage, preoperative albumin, age, and BMI.

RESULTS: The RTG group had significantly earlier pathological TNM staging (Stage I: 40.5% vs. 21.7%, p=0.003) and higher preoperative albumin (40.8 vs. 39.05 g/L, p<0.001). In univariate analysis, the RTG group demonstrated shorter median postoperative hospital stay (6 vs. 9 days, p<0.001), a markedly lower rate of prolonged hospitalisation >14 days (1.7% vs. 14.5%, OR = 10.1, p=0.001), earlier first oral intake (6 vs. 42.75 h, p<0.001), earlier first ambulation (20 vs. 38 h, p<0.001), fewer ICU admissions (5.0% vs. 17.4%, p=0.002), a higher rate of adequate lymph node dissection (≥10 groups: 72.7% vs. 44.2%, p<0.001), a lower rate of clinically significant blood loss (>100 ml: 2.5% vs. 19.6%, p<0.001), and significantly better preservation of postoperative albumin on day 1 (Δ -2.0 vs. Δ -3.9 g/L, p=0.001) and day 5 (Δ -0.7 vs. Δ -3.2 g/L, p<0.001). The largest recovery gap was observed in total gastrectomy (7 vs. 11 days, p=0.002) despite equal operative time (285 vs. 288 min, p=0.969). In multivariate regression adjusting for all covariates, the robotic approach remained independently associated with all primary recovery outcomes (hospital stay β=-3.25 days, first liquid intake β=-41.71 h, first ambulation β=-16.45 h, drain duration β=-1.79 days; all p<0.001). The overall complication rate did not differ significantly (5.0% vs. 7.2%, OR = 0.68, 95% CI 0.24-1.94, p=0.606); post-hoc power was 11.6%, indicating the comparison was statistically inconclusive.

CONCLUSION: Robotic radical gastrectomy within a uniform ERAS protocol is independently associated with superior short-term postoperative recovery - including shorter hospitalisation, earlier oral intake, better nutritional preservation, and higher-quality lymph node dissection - compared to laparoscopic surgery, an advantage that persists after multivariate adjustment for tumour stage and is consistent across all subgroups examined. Multi-centre prospective trials are required to confirm long-term oncological outcomes.