Robotic versus laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis of perioperative and oncologic outcomes

BACKGROUND: While robotic total gastrectomy (RTG) has gained traction in minimally invasive gastric cancer surgery, high-level evidence comparing its efficacy with laparoscopic total gastrectomy (LTG) remains limited. This systematic review and meta-analysis aimed to comprehensively evaluate the comparative efficacy and safety of RTG versus LTG in gastric cancer patients, thereby informing evidence-based surgical decision-making. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases from inception until November 2024 for comparative studies of RTG and LTG. Perioperative outcomes (intraoperative blood loss, severe complications [Clavien-Dindo grade ≥3], abdominal infection rates, postoperative hospitalization) and oncologic parameters (retrieved lymph nodes, 3-year overall survival [OS], disease-free survival [DFS]) were analyzed. Risk ratios and weighted mean differences (WMD) with 95% confidence intervals were calculated. Protocol registered with PROSPERO. RESULTS: The results revealed that RTG significantly reduced severe complications (CD ≥3), abdominal infection, intraoperative blood loss, and postoperative hospital stay compared to LTG. Additionally, RTG led to an increased number of retrieved lymph nodes. However, no significant differences were observed in 3-year OS and DFS between RTG and LTG, consistent with findings from other types of gastrectomy. The subgroup analysis demonstrated that the use of linear staplers was more effective in reducing severe complications and postoperative hospital stay. CONCLUSION: RTG confers superior perioperative safety profiles compared to LTG while maintaining equivalent oncologic outcomes. The technical advantages of robotic platforms - particularly enhanced instrument maneuverability in narrow spaces - may explain reduced intraoperative trauma and complication risks. These findings support RTG as a viable option for centers with robotic expertise, though cost-effectiveness analyses remain warranted.