Comparison of short- and mid-term outcomes of robotic versus laparoscopic gastrectomy in high-risk patients with gastric cancer: a nationwide, multicentre cohort study
Menée à l'aide de données multicentriques portant sur 2 001 patients atteints d'un cancer de l'estomac à haut risque de progression, cette étude compare les résultats à court et moyen terme de 2 types de gastrectomies, l'une assistée par robot et l'autre par voie laparoscopique
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.
European Journal of Surgical Oncology , résumé, 2025