[A comparative analysis of the short-term efficacy of single-port and multi-port robotic distal gastrectomy for gastric cancer: a propensity score matched cohort study].

Objective: To compare the short-term outcomes of distal radical gastrectomy for gastric cancer using domestically produced single-port and multi-port robotic systems. Methods: This retrospective cohort study included 168 patients with gastric cancer who underwent robot-assisted radical gastrectomy at the Third Department of Surgery, the Fourth Hospital of Hebei Medical University, between September 2023 and July 2025. The initial cohort included 115 males and 53 females, with an age of (60.1±10.5) years (range: 36 to 78 years). Among them, 127 patients underwent multi-port robotic surgery (MP group) and 41 underwent single-port robotic surgery (SP group). To minimize baseline differences, 1∶1 nearest-neighbor propensity score matching was performed (the caliper value was set to 0.2), yielding 41 matched patients in each group. Intraoperative variables and early postoperative outcomes were compared using the independent-samples t test, Mann-Whitney U test, chi-square test, or Fisher's exact test, as appropriate. Results: After matching, baseline characteristics were well-balanced. All procedures were successfully completed as R0 resections without conversion to open surgery. Compared with the MP group, the SP group had a longer total operative time (M(IQR) (246.0 (52.0) min vs. 198.0 (40.0) min, Z=-5.862, P<0.01), longer instrument setup time (19.0 (3.0) min vs. 15.0 (3.0) min, Z=-6.986, P<0.01), and longer lymph node dissection time (158.0 (42.0) min vs. 112.0 (24.0) min, Z=-6.271, P<0.01). Gastrointestinal reconstruction time, intraoperative blood loss, and the number of retrieved lymph nodes did not differ significantly between the two groups (all P>0.05). The SP group showed earlier postoperative ambulation (1.0 (0) d vs. 2.0 (1.0) d, Z=-3.661, P<0.01) and earlier recovery of bowel function (2.0 (1.0) d vs. 3.0 (1.0) d, Z=-2.499, P=0.012). No significant between-group differences were observed in time to first postoperative fluid intake (3.0 (1.0) d vs. 3.0 (1.0) d, Z=-1.278, P=0.201), time to first liquid diet (5.0 (1.0) d vs. 5.0 (1.0) d, Z=-1.012, P=0.312), or postoperative hospital stay (7.0 (2.0) d vs. 7.0 (3.0) d, Z=-0.442, P=0.842). The SP group reported lower Scar Assessment Scale scores ((7.8±1.6) points vs. (9.4±2.0) points, t=-3.893, P<0.01) and lower pain scores on postoperative days 1 to 3 (all P<0.05). Additionally, inflammatory markers (neutrophil-to-lymphocyte ratio and systemic immune-inflammation index) were significantly lower in the SP group on postoperative days 1 and 3 (all P<0.05). Postoperative complication rates were similar between the SP and MP groups (9.8% (4/41) vs. 12.2% (5/41), P=1). No Clavien-Dindo classification of surgical complications grade Ⅲ or higher complications occurred in either group. Conclusions: This study provides preliminary evidence that single-port robotic distal radical gastrectomy for gastric cancer is a safe and feasible approach. Short-term outcomes were generally comparable to those of multi-port robotic surgery,with potential advantages in early postoperative pain,recovery of gastrointestinal function,and cosmetic results.