Comparison of total robotic distal gastrectomy and robot-assisted distal gastrectomy for gastric cancer: a systematic review and meta-analysis.

Gastric cancer continues to account for a substantial proportion of cancer-related mortality worldwide. Total robotic distal gastrectomy (TRDG) and robot-assisted distal gastrectomy (RADG) are increasingly used, but their comparative outcomes are not well established. This study followed PRISMA criteria to perform a systematic review and meta-analysis. Searches were carried out in PubMed, EMBASE, the Cochrane Library, and Web of Science up to July 2025. Outcomes assessed were operation time, hospital stay, incision length, gastrointestinal recovery, blood loss, and complications. Combined odds ratios (ORs) and weighted mean differences (WMDs), each accompanied by 95% confidence intervals (CIs), were derived through the application of random-effects models. The methodological rigor of each included study was assessed using the Newcastle-Ottawa Scale. Four retrospective studies with 773 patients were included. TRDG had a longer operation time (WMD 5.95 min; 95% CI 1.93-9.97; p < 0.05) but showed benefits including shorter hospital stay (WMD - 1.17 days; 95% CI - 2.13 to - 0.21), faster gastrointestinal recovery (WMD - 0.44 days; 95% CI - 1.87 to - 0.01), and smaller incisions (WMD - 2.95 cm; 95% CI - 3.88 to - 2.02). No meaningful differences were identified between the groups regarding intraoperative blood loss or the incidence of postoperative complications. TRDG provides advantages in recovery and wound size without increasing complications, supporting its use as a safe alternative to RADG. Further prospective research is needed to validate these results and to assess long-term outcomes comprehensively.