Robotic Versus Laparoscopic Gastrectomy for Advanced Gastric Cancer: Prognostic Implications of Surgical Recovery and Oncologic Control in a Propensity Score-Matched Study.

Abstract

Robotic gastrectomy may improve precision during radical lymphadenectomy, but its prognostic relevance in advanced gastric cancer remains uncertain. The authors hypothesized that robotic surgery may influence outcomes through improved recovery and oncologic control. A prospectively maintained registry included 426 curative-intent minimally invasive gastrectomies from 2017 to 2025 (laparoscopic, n = 176; robotic, n = 250). Propensity score-matching yielded 154 pairs. Endpoints included severe morbidity (Clavien-Dindo grade ≥ III), postoperative inflammation, adjuvant chemotherapy delivery, recurrence patterns, overall survival (OS), and relapse-free survival (RFS). Robotic gastrectomy independently reduced severe complications in the entire cohort (odds ratio, 0.31; 95% confidence interval [CI] 0.13-0.73; P = 0.007). After matching, the results showed that robotic surgery reduced both severe complications (2.6% [4/154] vs. 9.7% [15/154]; P = 0.016) and C-reactive protein levels (day 1, P = 0.001; day 3, P = 0.007; maximum, P = 0.005). In matched pStages II and III disease, robotic surgery improved chemotherapy completion (63.6% vs. 40.5%; P = 0.026), showed numerically fewer nodal and peritoneal recurrences, and was associated with higher estimated 5-year OS (71.7% vs. 52.0%; P = 0.046). After pStage II or III distal gastrectomy, the estimated 5-year OS was 78.9% vs. 53.4% (P = 0.004), and the estimated RFS was 79.2% vs. 53.4% (P = 0.050). An exploratory analysis of T4 distal gastrectomy showed a favorable OS signal (68.0% vs. 40.4%; P = 0.029). Robotic gastrectomy may have prognostic relevance through two complementary pathways: a recovery pathway characterized by reduced morbidity, attenuated inflammation, and improved adjuvant chemotherapy delivery and an oncologic-control pathway characterized by precise lymphadenectomy and gentler tumor-handling. However, survival and recurrence findings remain exploratory and require prospective validation.