Operative safety and oncologic outcomes of robotic and laparoscopic total gastrectomy for advanced middle-upper gastric cancer: a multicenter retrospective study

Background: Robotic total gastrectomy (RTG) has been proposed as a promising alternative to laparoscopic total gastrectomy (LTG) for advanced middle-upper gastric cancer (AMUGC) due to its potential to overcome anatomical challenges. However, the comparative evidence regarding both safety and long-term oncologic efficacy remains limited. Methods: This retrospective cohort study included 1099 patients with AMUGC who underwent RTG/LTG at eight high-volume centers in China between 2015 and 2019. Propensity score matching (PSM = 1:1) was used to balance clinicopathological characteristics between the two groups. The primary outcome was 3-year disease-free survival (DFS); secondary outcomes included 3-year overall survival (OS), 3-year cumulative incidence of recurrence (CIR), recurrence patterns, and operative outcomes. Results: In the PSM cohort, 229 patients were included in each group. RTG demonstrated lower overall postoperative complications (16.2% vs. 27.1%, P 0.05). Multivariate analysis confirmed that the surgical method was not significantly associated with 3-year DFS hazard ratio (HR), 0.767; 95% confidence interval (CI), 0.542–1.086; P = 0.135 or 3-year OS (HR, 0.774; 95% CI, 0.534–1.122; P = 0.177). Conclusions: For AMUGC patients not receiving neoadjuvant chemotherapy, RTG demonstrated potential advantages in certain operative outcomes and non-inferior 3-year oncological outcomes compared with LTG. Prospective trials are needed to validate these findings.