Laparoscopic vs robot-assisted gastrectomy in gastric cancer patients with prior abdominal surgery: a propensity-matched analysis.

No studies have compared the efficacy of laparoscopic gastrectomy (LG) and robot-assisted gastrectomy (RG) for gastric cancer (GC) patients with a history of abdominal surgery (HAS). This is the first study in this field to identify complication-related factors and compare survival outcomes using propensity score matching (PSM) and a competing risk model (CRM). A retrospective cohort study was conducted on GC patients with HAS who underwent radical LG or RG. PSM was applied to achieve baseline balance. Univariate and multivariate regression analyses were performed to identify factors independently associated with complications. CRM adjusted by inverse probability of censoring weighting (IPCW) was used to analyze overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) across different TNM stages. PSM with a 3:1 ratio ensured baseline balance while minimizing sample loss (LG n = 87, RG n = 29). RG was associated with a significantly longer surgery duration but a lower incidence of overall and Clavien-Dindo (CD) grade ≥ 2 complications. Multivariate analysis identified RG (OR, 95% CI: 0.02, 0.01-0.15), surgery duration (OR, 95% CI: 1.01, 1.00-1.01), and lymphadenectomy extent (OR, 95% CI: 2.81, 1.16-7.25) as independent factors associated with overall complications. Likewise, RG (OR, 95% CI: 0.06, 0.01-0.38), surgery duration (OR, 95% CI: 1.01, 1.00-1.02), and tumor size (OR, 95% CI: 1.02, 1.00-1.04) were independently associated with CD grade ≥ 2 complications. Kaplan-Meier analyses based on IPCW-adjusted CRM showed no significant differences in OS, CSS, and DFS between RG and LG across TNM stages. RG may efficiently reduce complications compared to LG but offers no survival benefit, suggesting a potential advantage in perioperative safety for GC patients with HAS.