ArticleAnnals of surgical oncology2026
Robotic Versus Laparoscopic Gastrectomy for Advanced Gastric Cancer: Prognostic Implications of Surgical Recovery and Oncologic Control in a Propensity Score-Matched Study.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
Authors and funding
13 authors.
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Abstract
backgroundRobotic 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.
methodsA 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).
resultsRobotic 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).
conclusionsRobotic 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.
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