Robotic versus laparoscopic gastrectomy for gastric cancer: 5-year long-term results from a randomized controlled trial
In brief
Robotic gastrectomy shows no significant 5-year survival advantage over laparoscopy
In this randomized trial, 5-year relapse-free survival was 69% after laparoscopic surgery and 75% after robotic surgery; overall survival was 71% and 79%, respectively, with neither difference statistically significant. Subgroup analyses favored robotic surgery in men and after distal gastrectomy, but whether those signals represent a real benefit remains uncertain.
- Journal
- Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (Q1)
- Published
- 4 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Junya Kitadani, Keiji Hayata, Toshiyasu Ojima, Shinta Tominaga, Taro Goda, Tomoki Nakai, et al.
- PMID
- 42980995
- DOI
- 10.1007/s10120-026-01813-z
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 6 November 2026): Randomized comparison of gastrectomy approaches and long-term oncologic outcomes
Abstract
BACKGROUND: Despite increasing global adoption of robotic approaches, the comparative effectiveness of robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer is uncertain, particularly regarding long-term oncologic outcomes. METHODS: This phase III randomized controlled trial (RCT) enrolled 241 patients with resectable gastric cancer (clinical stages I-III) between April 1, 2018, and October 31, 2020. Patients were randomly assigned to undergo either robotic gastrectomy or laparoscopic gastrectomy. The primary endpoint was postoperative intra-abdominal infectious complications (previously reported). Secondary endpoints included long-term oncologic outcomes, specifically relapse-free survival, overall survival and patterns of recurrence. RESULTS: This study enrolled 241 patients, with 236 patients in the modified intention-to-treat population. The 5-year relapse-free survival in the modified intention-to-treat population did not significantly differ between the laparoscopic gastrectomy and robotic gastrectomy groups (69% vs. 75%). Similarly, overall survival was not significantly different between the groups (71% vs. 79%). The 5-year cumulative incidence of primary disease-specific death was comparable between the groups (16.1% vs. 11.6%). Patterns of recurrence did not differ between them. In subgroup analyses, the robotic gastrectomy group demonstrated significantly better overall survival than the laparoscopic gastrectomy group among male patients (HR, 0.48; 95% CI, 0.25-0.95). Among patients that underwent distal gastrectomy, the robotic gastrectomy group showed a significantly lower cumulative incidence of primary disease-specific death than the laparoscopic gastrectomy group (HR, 0.24; 95% CI, 0.07-0.81). CONCLUSION: In this RCT, secondary endpoint analyses showed no statistically significant differences in 5-year relapse-free survival or overall survival between laparoscopic gastrectomy and robotic gastrectomy. TRIAL REGISTRATION: umin.ac.jp/ctr Identifier UMIN000031536.
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.