Assessment of robotic versus laparoscopic gastrectomy for gastric cancer patients with intraoperative technical complexity: a multicenter retrospective study.

[BACKGROUND] While robotic gastrectomy (RG) is increasingly used in gastric cancer surgery, its potential advantages over laparoscopic gastrectomy (LG) in intraoperative technical complexity (ITC) cases remain debated.

[METHODS] This retrospective cohort study included 3534 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals. ITC was defined by any of the following criteria: operative time exceeding the third quartile, intraoperative estimated blood loss ≥400 mL, or conversion to open surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were conducted to compare short- and long-term outcomes.

[RESULTS] Patients with ITC comprised 25.9% (916/3534) of the cohort (RG: 260, LG: 656). After baseline adjustment, RG and LG groups were comparable in both PSM and IPTW cohorts. RG showed lower overall postoperative complications (11.5% vs. 20.1%, P = 0.003), particularly pneumonia (2.3% vs. 11.0%, P < 0.001) and shorter postoperative hospital stay (9.33 ± 4.41 vs. 10.77 ± 5.91 days, P < 0.001) compared to LG. These differences remained significant after PSM and IPTW analysis. The 3-year overall survival (83% vs. 78.8%, P = 0.15), disease-free survival (81.9% vs. 76.2%, P = 0.073), and cumulative recurrence risk (16.9% vs. 20%, P = 0.26) were comparable between RG and LG groups, consistent after PSM and IPTW. Multivariate analysis indicated that the surgical approach was not an independent factor influencing technical complexity.

[CONCLUSIONS] For patients with ITC, RG demonstrated superior short-term and comparable long-term outcomes than LG.