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.