Textbook oncological outcomes of robotic and laparoscopic gastrectomy for locally advanced cancer: a propensity score-matched analysis.

[BACKGROUND] Surgical resection is essential for treating locally advanced gastric cancer. Laparoscopic gastrectomy (LG) is minimally invasive but limited because it has no articulated forceps, no motion scale, and no tremor filtering; this has led to robotic gastrectomy (RG) being adopted. Although RG may offer technical advantages, its superiority over LG in surgical and survival outcomes remains unclear. The concept of the textbook oncological outcome (TOO) is a composite measure of surgical quality. In this study, RG and LG were compared in terms of surgical and survival outcomes using TOO as a measure.

[METHODS] This study included 339 patients with clinical stage II or III gastric cancer, 167 of whom underwent LG and 172 of whom underwent RG. After propensity score matching, data for 126 pairs were analyzed. Surgical and survival outcomes were assessed based on TOO achievement.

[RESULTS] The overall TOO achievement rate was 40.1%. The RG group showed significantly better outcomes in no severe complications (98.4 vs. 89.7%, P = 0.006), no re-intervention (98.4 vs. 91.3%, P = 0.019), no ICU admission (99.2 vs. 92.9%, P = 0.019), and CRP ≤ 10 mg/dL on postoperative day 6 (84.1 vs. 66.7%, P = 0.002). Consequently, TOO achievement was significantly higher in the RG group (47.6 vs. 32.5%, P = 0.020). RG was an independent favorable factor for TOO achievement (OR 1.900, 95% CI 1.120-3.240, P = 0.018). Survival analysis showed significantly higher 3-year overall survival in the TOO-achieved group than in the non-achieved group (86.2 vs. 65.5%, P = 0.013). TOO achievement was an independent favorable prognostic factor for overall survival (HR 0.370, 95% CI 0.205-0.664, P < 0.01).

[CONCLUSIONS] RG contributed to higher TOO achievement, and achieving TOO significantly improved survival. Promoting RG may be an effective strategy to enhance oncological outcomes in locally advanced gastric cancer.