Comparison of short- and long-term outcomes for robotic versus laparoscopic gastrectomy in elderly patients with gastric cancer: a multicenter cohort study

Background: There is limited evidence from large-scale multicenter studies regarding the short- and long-term efficacy of robotic gastrectomy (RG) in elderly patients diagnosed with gastric cancer (GC). As such, this retrospective investigation compared short-term outcomes and long-term oncological prognoses of RG versus (vs.) laparoscopic gastrectomy (LG) in a representative sample of this population. Methods: Data from 1393 patients ≥ 65 years of age diagnosed with GC, who underwent radical gastrectomy at 8 large tertiary hospitals in China between August 2016 and June 2019, were analyzed. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to reduce confounding bias. Results: After IPTW and PSM adjustments, baseline characteristics between the RG and LG groups were comparable (standardized mean difference < 0.10). After IPTW adjustment, mean blood loss in the RG group was significantly less than that in the LG group (89.36 vs. 103.39 mL; p = 0.046) as was mean length of hospital stay (9.62 vs. 10.47 days; p = 0.017). There were no statistical differences in postoperative complications between the RG and LG groups (p > 0.05), nor in 3y-DFS (IPTW-adjusted: 74.5% vs. 74.6%, p = 0.957; PSM-adjusted: 76.8% vs. 79.3%, p = 0.323) or 3y-OS (IPTW-adjusted: 75.9% vs. 77.0%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235). Similarly, there were no significant differences in postoperative recurrence rates between the RG and LG groups (IPTW-adjusted: 21.1% vs. 20.5%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235). Conclusion: RG yielded superior short-term outcomes compared with LG in elderly patients diagnosed with GC, while achieving comparable long-term outcomes and demonstrating safety and effectiveness.