Comparison of Short-Term and Long-Term Efficacy of Robotic and Laparoscopic Gastrectomy in High-Risk Gastric Cancer Population: A Nationwide Multicenter Cohort Study

Authors
Qiu wen wu, He qi-chen, Zhao yu xuan, Huang ze-ning, Ping Li

Affiliations
Fujian Medical University Union HospitalDepartment of Gastric Surgery

Background
To compare short-term and long-term outcomes of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) in high-risk gastric cancer (GC) patients.

Methods
This retrospective study included 4120 GC patients undergoing gastrectomy in 8 large-capacity tertiary hospitals in China between August 2016 and June 2019. Patients with ≥1 of the following conditions were defined as high-risk: 1) age ≥80 years; 2) BMI ≥30 kg/m2; 3) ASA grade ≥III; 4) clinical T stage (cT4). Finally, 2001 patients were included in this study and underwent 1:1 propensity score matching (PSM) with 534 patients in each group.

Results
Compared with the LG group, the RG group demonstrated less intraoperative estimated blood loss(p=0.010) and lower overall postoperative complication rate (P=0.002). The 3-year recurrence-free survival (RFS) rates were 78.97% and 75.45% for the RG and LG groups, respectively (log-rank, P=0.220). The 3-year cumulative incidence Function (CIF) rates under the competing risk model were 18.74% and 21.54%, respectively (Fine-Gray P=0.647). Subgroup analysis revealed no significant differences in RFS and CIF between the RG and LG groups across pathological stages I, II, and III (all P>0.05). However, in the pN3b stage, the RG group demonstrated superior RFS (63.74% vs. 32.74%, log-rank, P=0.002) and lower 3-year CIF (30.51% vs. 61.13%, Fine-Gray P=0.002) compared to the LG group. Multivariable Cox regression analysis showed that RG was not an independent factor for 3-year RFS (HR: 0.853, 95% CI: 0.662-1.099, P=0.218). At 3-year follow-up, recurrence occurred in 105 RG patients (22.47%) and 120 LG patients (19.66%, P=0.294), with comparable median time to recurrence across pathological stages (all P>0.05). In pN3b, the RG group exhibited lower overall and peritoneal recurrence rates (P<0.05).

Conclusion
For resectable high-risk GC, RG demonstrated superior short-term outcomes. In the high-risk pN3b subgroup, RG exhibited lower recurrence rates and improved prognosis compared to LG.