Disparities in use and outcomes of robotic surgery for gastric cancer: An evaluation of a large national cohort.

Abstract

Robotic-assisted gastrectomy (RG) has emerged as a promising surgical option for gastric cancer, offering potential clinical benefits over open and laparoscopic approaches. However, disparities in its use remain underexplored. A retrospective analysis of 47,688 patients with gastric adenocarcinoma from the National Cancer Database (2010-2021) was conducted to assess surgical trends, clinical outcomes, and sociodemographic disparities in RG use. Multivariable logistic and Cox regression models were used to examine short- and long-term outcomes and to identify predictors of RG use. Use of RG for gastric adenocarcinoma rose from 1.45% in 2010 to 26.57% in 2021. Compared with open and laparoscopic surgery, RG was associated with improved intra- and postoperative outcomes, including shorter length of stay, more lymph nodes retrieved, and improved overall survival. However, 5 key factors-older age, female sex, Black race, uninsured status, and lower area median income-were associated with decreased odds of receiving RG. Disparities related to income and insurance were attributed to access to RG-capable facilities, whereas disparities related to sex persisted within such facilities, suggesting potential provider- or institution-level influences. Race and age disparities were attributed to both access to RG-capable facilities and provider- or institution-level influences within such facilities. Although RG adoption is increasing and associated with favorable outcomes, access remains unequal. Targeted efforts to reduce both structural and provider-level barriers are necessary to ensure equitable use of this advanced surgical modality.