Surgical and Oncologic Outcomes of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: Real-World Data From a Multi-Institutional Propensity Score-Matched Study.

INTRODUCTION

Robotic gastrectomy (RG) has been increasingly adopted for gastric cancer (GC). Although high-volume centers report superior outcomes compared with laparoscopic gastrectomy (LG), real-world evidence remains limited. This study compared short- and long-term outcomes of robotic distal gastrectomy (RDG) and laparoscopic distal gastrectomy (LDG) using propensity score matching.

METHODS

Patients who underwent curative RDG or LDG between April 2018 and December 2024 were retrospectively reviewed. Propensity score matching was performed based on demographics, clinical factors, surgical procedures, pathological stage (Japanese Classification of Gastric Carcinoma), and perioperative chemotherapy. Surgical, postoperative, and oncological outcomes were compared.

RESULTS

Among 821 patients, 228 matched pairs were analyzed. Operative time was longer in the RDG group than in the LDG group (median 333 vs. 272.5 min, p < 0.0001). RDG was associated with lower rates of postoperative intra-abdominal infectious complications, both overall and Clavien-Dindo grade ≥ II. Postoperative hospital stay was shorter in the RDG group (median 9 vs. 10 days, p = 0.0126). In patients with pathological stage III disease, operative time did not differ significantly between groups. The maximum postoperative serum C-reactive protein level was lower in the RDG group, indicating a reduced inflammatory response. Overall and recurrence-free survival did not differ significantly between groups.

CONCLUSION

RDG was associated with fewer intra-abdominal infections, shorter hospital stay, and reduced inflammatory response compared with LDG. For advanced GC (pStage III), RDG did not increase operative time and may provide clinical advantages. RG may be particularly beneficial for patients with advanced disease.