Operative safety and oncologic outcomes of robotic and laparoscopic total gastrectomy for advanced middle-upper gastric cancer: a multicenter retrospective study
In brief
Robotic gastrectomy cuts postoperative complications by 11 percentage points
In a matched analysis of 229 patients each, robotic total gastrectomy lowered overall complication rates to 16.2% versus 27.1% with laparoscopy, chiefly reducing medical issues and pneumonia. Disease-free and overall survival at three years were similar, with a modest DFS advantage only in stage III disease, indicating comparable oncologic efficacy while improving short-term safety.
- Journal
- International journal of surgery (London, England) (Q1)
- Published
- 1 June 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Hua-Long Zheng, Hong-Hong Zheng, Tai-Yuan Li, Li Zhang, Jun-Jun She, Bao-Qing Jia, et al.
- PMID
- 42682346
- DOI
- 10.1097/JS9.0000000000005070
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 4 September 2026): Robotic vs laparoscopic total gastrectomy, oncologic outcomes
Abstract
BACKGROUND: Robotic total gastrectomy (RTG) has been proposed as a promising alternative to laparoscopic total gastrectomy (LTG) for advanced middle-upper gastric cancer (AMUGC) due to its potential to overcome anatomical challenges. However, the comparative evidence regarding both safety and long-term oncologic efficacy remains limited. METHODS: This retrospective cohort study included 1099 patients with AMUGC who underwent RTG/LTG at eight high-volume centers in China between 2015 and 2019. Propensity score matching (PSM = 1:1) was used to balance clinicopathological characteristics between the two groups. The primary outcome was 3-year disease-free survival (DFS); secondary outcomes included 3-year overall survival (OS), 3-year cumulative incidence of recurrence (CIR), recurrence patterns, and operative outcomes. RESULTS: In the PSM cohort, 229 patients were included in each group. RTG demonstrated lower overall postoperative complications (16.2% vs. 27.1%, P < 0.05), medical complications (6.6% vs. 17.0%, P < 0.05), and pneumonia rates (6.6% vs. 16.2%, P < 0.05). No differences were observed in 3-year DFS (73.7% vs. 68.1%, P = 0.230), 3-year OS (76.8% vs. 72.4%, P = 0.326), CIR (24.4% vs. 26.8%, P = 0.580), and recurrence patterns. In stage III, 3-year DFS was higher in the RTG group (67.4% vs. 54.5%, P = 0.047), but no significant differences were found in 3-year OS or CIR (all P > 0.05). Multivariate analysis confirmed that the surgical method was not significantly associated with 3-year DFS [hazard ratio (HR), 0.767; 95% confidence interval (CI), 0.542-1.086; P = 0.135] or 3-year OS (HR, 0.774; 95% CI, 0.534-1.122; P = 0.177). CONCLUSIONS: For AMUGC patients not receiving neoadjuvant chemotherapy, RTG demonstrated potential advantages in certain operative outcomes and non-inferior 3-year oncological outcomes compared with LTG. Prospective trials are needed to validate these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.