Comparison of short- and mid-term outcomes of robotic versus laparoscopic gastrectomy in high-risk patients with gastric cancer: a nationwide, multicentre cohort study

Background: To compare short-term and mid-term outcomes of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) in high-risk gastric cancer (GC) patients. Methods: Patients with ≥1 of the following criteria were defined as high-risk: age ≥80 years; BMI ≥30 kg/m²; ASA grade ≥ III; and clinical T stage (cT4). Finally, 2001 patients who underwent radical gastrectomy between August 2016 and June 2019 at eight high-volume hospitals were included and underwent 1:1 propensity score matching (PSM) with 534 patients in each group. Results: After PSM, the RG group experienced less intraoperative blood loss (111.35 vs. 132.46 ml; P < 0.001) and a lower incidence of intraoperative massive haemorrhage (2.81 % vs. 5.62 %;P = 0.022), postoperative grade I–II complications (9.93 % vs.13.86 %; P = 0.047), medical complications (3.93 % vs. 8.61 %; P = 0.002), pneumonia (3.37 % vs. 7.30 %; P = 0.004), and pleural effusion (0.00 % vs. 0.75 %; P = 0.045) than the LG group. However, RG were associated with longer operative time (225.13 vs 210.51 min, P < 0.001) and significantly higher costs ($11,990 vs $8,040, P < 0.001). The three-year cumulative mortality rate (RG: 18.74 % vs. LG: 21.54 %, P = 0.280) and 3-year disease-free survival rate (RG: 78.97 % vs. LG: 75.45 %, P = 0.220) exhibited no statistically significant differences between surgical approaches. The 3-year overall recurrence rate was not significantly different between the RG and LG groups (22.47 % vs. 19.66 %; P = 0.294). Conclusions: RG yielded better short-term outcomes and comparable mid-term prognoses than LG for patients with high-risk resectable gastric cancer.