Robotic gastrectomy for gastric cancer: feasibility and outcomes of a newly established program

Abstract

Aim: Robotic-assisted surgery has emerged as a minimally invasive alternative to open gastrectomy for gastric cancer, offering potential advantages in visualization, instrument precision, surgeon posture, and decreased length of stay (LOS). This study compares peri-operative and oncologic outcomes between robotic and open gastrectomy during an institutional transition to robotic-assisted gastric surgery.

Methods: A retrospective cohort study was conducted of 56 patients who underwent curative-intent gastrectomy for gastric adenocarcinoma between February 2016 and December 2024. Twenty-seven patients underwent robotic-assisted gastrectomy and 29 underwent open surgery. Demographic, operative, pathologic, and postoperative outcomes were compared using Fisher’s exact and Wilcoxon rank-sum tests, with overall survival analyzed by Kaplan–Meier methods.

Results: Baseline characteristics were comparable between groups. Operative time was significantly longer for robotic surgery (median 320 vs. 255 minutes, P = 0.012), but estimated blood loss was lower (100 vs. 175 mL, P = 0.025). Operative complications were significantly fewer in the robotic group (7.4% vs. 31.0%, P = 0.042), and postoperative LOS was significantly shorter (7 vs. 9 days, P = 0.025). While lymph-node yield, R0 resection rate, and 5-year overall survival were numerically higher in the robotic group, these differences did not reach statistical significance.

Conclusion: Robotic gastrectomy demonstrated reduced blood loss, fewer complications, and shorter hospitalization compared with open surgery, with equivalent oncologic outcomes. These findings support the safety and feasibility of robotic gastrectomy during program implementation with significant benefits to the patients.

Keywords

Gastric adenocarcinoma / robotic gastrectomy / program implementation / minimally invasive surgery

References

[1] Bray F,Sung H.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin2024;74:229-63

[2] Leong T,Haustermans K.TOPGEAR: a randomized, phase III trial of perioperative ECF chemotherapy with or without preoperative chemoradiation for resectable gastric cancer: interim results from an international, intergroup trial of the AGITG, TROG, EORTC and CCTG.Ann Surg Oncol2017;24:2252-8

[3] Cats A, Jansen EPM, van Grieken NCT, et al.; CRITICS investigators. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial.Lancet Oncol2018;19:616-28 PMCID:PMC6985115

[4] Cui S, Liang H, Li Y, et al.; Chinese Peritoneal Oncology Study Group. PILGRIM: phase III clinical trial in evaluating the role of hyperthermic intraperitoneal chemotherapy for locally advanced gastric cancer patients after radical gastrectomy with D2 lymphadenectomy (HIPEC-01).J Clin Oncol2020;38:4538

[5] Kim YW,Yoon HM.Laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer: a randomized clinical trial.J Clin Oncol2022;40:2342-51 PMCID:PMC9287280

[6] Al-Batran S,Riera J.Effect of chemotherapy/targeted therapy alone vs. chemotherapy/targeted therapy followed by radical surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction: the IKF-575/RENAISSANCE phase III trial.J Clin Oncol2024;42:LBA4001

[7] NCCN. Gastric Cancer. 2025 Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1434. [Last accessed on 27 May 2026]

[8] Waller GC,Correa-Gallego C.Minimally invasive gastrectomy.Surg Clin North Am2025;105:15-30

[9] Hashizume M,Tomikawa M.Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system.Surg Endosc2002;16:1187-91

[10] Solaini L,Pacilio CA,Cavaliere D.Robotic surgery for gastric cancer in the west: a systematic review and meta-analyses of short-and long-term outcomes.Int J Surg2020;83:170-5

[11] Perez Holguin RA,Hendriksen BS.Predictors of conversion during minimally invasive gastrectomy for malignancy.J Surg Res2022;279:275-84

[12] Chen C,Yang A.Risk of open conversion during robotic gastrectomy for gastric cancer: optimizing patient selection.J Surg Oncol2025;132:503-13 PMCID:PMC12455542

[13] Ojima T,Hayata K.Short-term outcomes of robotic gastrectomy vs laparoscopic gastrectomy for patients with gastric cancer: a randomized clinical trial.JAMA Surg2021;156:954-63 PMCID:PMC8411361

[14] Ribeiro U Jr,Ramos MFKP.Short-term surgical outcomes of robotic gastrectomy compared to open gastrectomy for patients with gastric cancer: a randomized trial.J Gastrointest Surg2022;26:2477-85

[15] Nakauchi M,Janjigian YY.Comparison of long- and short-term outcomes in 845 open and minimally invasive gastrectomies for gastric cancer in the United States.Ann Surg Oncol2021;28:3532-44 PMCID:PMC8323986

[16] Trastulli S,Lin JX.Open vs robotic gastrectomy with D2 lymphadenectomy: a propensity score-matched analysis on 1469 patients from the IMIGASTRIC prospective database.Langenbecks Arch Surg2023;408:302

[17] Manara M,Bonitta G.Short-term outcomes analysis comparing open, lap-assisted, totally laparoscopic, and robotic total gastrectomy for gastric cancer: a network meta-analysis.Cancers2024;16:3404 PMCID:PMC11475391

[18] Bates KR,Liggett MR,Vitello DJ.Complications following open versus minimally invasive resection of gastric adenocarcinoma.J Surg Oncol2025;131:1302-12 PMCID:PMC12186106

[19] Garsot E, Sentí S, Salvador H, et al.; the Spanish EURECCA Esophagogastric Cancer Group. Outcomes of minimally invasive versus open gastrectomy for gastric cancer surgery with curative intent: a population-based cohort study.Ann Surg2025;282:800-9

[20] Liao G,Ren C.Robotic versus open gastrectomy for gastric cancer: a meta-analysis.PLoS One2013;8:e81946 PMCID:PMC3849388

[21] Hirata Y,Mansfield P,Ikoma N.Trends of oncological quality of robotic gastrectomy for gastric cancer in the United States.World J Oncol2023;14:371-81 PMCID:PMC10588505

[22] Hur H,Kim YW.Clinical efficacy of laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer: 5-year results of the SENORITA trial.Ann Surg2025;281:296-303

[23] Tobias-Machado M,Rubinstein M,Hidaka AK.Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?.Int Braz J Urol2016;42:83-9 PMCID:PMC4811230

[24] Khanna P,Blair Y.Beyond the console: a narrative review of robotic surgical education for urologic trainees.AME Med J2025;10:15