ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2026
Comparison of long-term outcomes of robotic gastrectomy and laparoscopic gastrectomy using the modified age-adjusted Charlson Comorbidity Index.
Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe modified age-adjusted Charlson Comorbidity Index (mACCI) is associated with postoperative complications and long-term survival after gastrectomy. However, whether robotic gastrectomy (RG) provides clinical advantages over laparoscopic gastrectomy (LG) in high-risk patients remains unclear. This study evaluated short- and long-term outcomes of RG compared with LG according to mACCI.
methodsA total of 1501 patients who underwent minimally invasive gastrectomy for clinical stage I-II gastric cancer between 2012 and 2021 were retrospectively analyzed. Patients were stratified by mACCI (< 4 and ≥ 4), and propensity score matching was performed within each stratum. Short-term outcomes, overall survival (OS), recurrence-free survival (RFS), and cumulative incidence of other-cause and gastric cancer-specific death were assessed.
resultsAmong patients with mACCI ≥ 4, RG was associated with a lower incidence of postoperative complications than LG after matching (2.7% vs. 8.2%, P = 0.036), including pancreatic fistula (0% vs. 3.3%, P = 0.030). RG showed significantly improved OS (HR 0.485, 95% CI 0.271-0.868, P = 0.015) and RFS (HR 0.417, 95% CI 0.236-0.738, P = 0.003). Competing risk analysis demonstrated a lower incidence of other-cause death in the RG group, whereas gastric cancer-specific mortality did not differ. No significant differences were observed between approaches in patients with mACCI < 4.
conclusionsRobotic gastrectomy was associated with reduced postoperative complications and improved long-term outcomes in high-risk patients with substantial comorbidities. RG may represent a preferable surgical approach in this population.
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