Clinical advantages of robotic gastrectomy for gastric cancer over conventional laparoscopic approach: a retrospective cohort study using a nationwide registry database in Japan

Objective: To evaluate contemporary short-term outcomes of robotic gastrectomy (RG) approximately 5 years after its widespread implementation, compared with laparoscopic gastrectomy (LG) using a nationwide Japanese database. Background: RG has been introduced to overcome the technical limitations of LG; however, its real-world clinical advantages remain to be fully defined. Methods: This retrospective study used the Japanese National Clinical Database to identify patients with gastric cancer who underwent minimally invasive distal gastrectomy (DG) or total gastrectomy (TG) between January 2023 and December 2024. Patients were classified as undergoing robotic (RDG or RTG) or laparoscopic (LDG or LTG) procedures. Propensity score matching was performed separately for the DG and TG cohorts to adjust for patient-, tumor-, and hospital-related confounders. The primary outcome was postoperative morbidity within 30 days (Clavien–Dindo grade ≥ IIIa). Results: After propensity score matching, 9743 RDG–LDG pairs and 1617 RTG–LTG pairs were analyzed. RDG was associated with a significantly lower morbidity rate than LDG (4.3 vs. 4.9%, P = 0.049). Despite longer operative time, RDG was associated with lower blood loss, lower conversion rates, fewer intra-abdominal infectious complications, and shorter postoperative hospital stay than LDG. Overall morbidity did not differ significantly between RTG and LTG (8.7 vs. 8.3%, P = 0.66); however, RTG was associated with lower blood loss, lower conversion rates, and shorter hospital stay. Conclusions: RDG was associated with improvements in multiple short-term outcomes, whereas RTG still did not improve the primary outcome measure.