Single-center, retrospective cohort study of perioperative outcomes in robotic-assisted, laparoscopic, and open distal gastrectomy: A propensity score matching analysis
Yinpeng Qiang, Vetshev Fedor, Sergey Osminin, Ildar Bilyalov, Evgeniya Panina, Natalia PetukhovaObjective
Robotic-assisted distal gastrectomy (RADG) and laparoscopic distal gastrectomy (LDG) serve as minimally invasive alternatives to open distal gastrectomy (ODG); however, the magnitude of their perioperative benefits remains controversial. This study aimed to compare the advantages and disadvantages of these minimally invasive approaches with conventional open surgery, identify the potential superiorities of RADG for the treatment of distal gastric cancer, and explore its clinical application value.
Methods
This single-center, retrospective cohort study enrolled patients diagnosed with gastric cancer (GC) who underwent distal gastrectomy between January 2020 and June 2026. All patients were divided into three groups according to the surgical procedure performed: the RADG group, the LDG group, and the ODG group. Propensity score matching (PSM) analysis was applied to mitigate confounding differences, and perioperative outcomes of RADG were separately compared with those of LDG and ODG. The primary outcomes included operative time, intraoperative blood loss (IBL), lymph node (LN) harvest number, and complication rates. Secondary outcomes consisted of R0 resection rates and postoperative hospital stays.
Results
After PSM, 41 patients in the RADG group were matched with 41 patients in the LDG group, and 40 patients in the RADG group were matched with 40 patients in the ODG group. Compared with LDG and ODG, RADG was associated with significantly less intraoperative blood loss (P=0.029 vs. LDG; P<0.001 vs. ODG), greater lymph node harvest yields (P=0.006 vs. LDG; P<0.001 vs. ODG), and shorter postoperative hospital stays (P=0.042 vs. LDG; P<0.001 vs. ODG). No significant differences in operative time were observed between RADG and LDG (P=0.605) or between RADG and ODG (P=0.418). All groups exhibited comparable R0 resection rates and severe complication rates.
Conclusions
RADG may yield favorable perioperative outcomes, including reduced IBL, improved LN retrieval, and shortened postoperative recovery time, without significantly increasing the incidence of severe perioperative complications.