Comparison of Short-term and Three-year Oncological Outcomes Between Robotic and Laparoscopic Gastrectomy for Gastric Cancer

Objective: To compare the short- and long-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. Summary Background Data: The clinical outcomes of RG over LG have not yet been effectively demonstrated. Methods: This retrospective cohort study included 3,599 patients with gastric cancer who underwent radical gastrectomy at eight high-volume hospitals in China from August 2016 to June 2019. Propensity score matching (PSM) was performed between patients who received RG and LG. The primary endpoint was 3-year disease-free survival (DFS). Results: After 1:1 PSM, 1034 pairs of patients were enrolled in a balanced cohort for further analysis. The 3-year DFS in the RG and LG was 83.7% and 83.1% ( P =0.745), respectively, and the 3-year overall survival (OS) was 85.2% and 84.4%, respectively ( P =0.647). During three years of follow-up, 154 patients in the RG and LG groups relapsed (cumulative incidence of recurrence: 15.0% vs. 15.0%, P =0.988). There was no significant difference in the recurrence sites between the two groups (all P >0.05). Sensitivity analysis showed that RG had comparable 3-year DFS (77.4% vs. 76.7%, P =0.745) and OS (79.7% vs. 78.4%, P =0.577) to LG in patients with advanced (pathological T2-4a) disease, and the recurrence pattern within three years was also similar between the two groups (all P >0.05). RG had less intraoperative blood loss, lower conversion rate, and shorter hospital stays than LG (all P >0.05). Conclusions: For resectable gastric cancer, including advanced cases, RG is a safe approach with comparable 3-year oncological outcomes to LG when performed by experienced surgeons.