Surgical Approaches for Primary Gastric GIST After the Introduction of Robotic Surgery: A 10-Year Single-Center Experience

Background/Objectives: Robotic surgery offers an additional minimally invasive option for gastric gastrointestinal stromal tumor (GIST) resection, particularly in anatomically demanding locations. Evidence regarding its integration into routine surgical practice remains limited. This study evaluated the evolution of surgical approaches for primary localized gastric GIST following the introduction of an institutional robotic program. Methods: We retrospectively analyzed 44 consecutive patients who underwent curative-intent resection for primary localized gastric GIST at a tertiary referral center between July 2015 and June 2025. Surgical management and perioperative outcomes were described for an early era (2015–2021; n = 29) and a later era after the introduction of robotic surgery (2022–2025; n = 15). Results: Overall, 22 procedures were completed laparoscopically, six robotically, and 13 through a primary open approach; three laparoscopic procedures were converted to open surgery. In the later era, robotic surgery accounted for 40.0% of resections, and no conversions occurred. The proportion of completed minimally invasive resections was 62.1% in the early era and 66.7% in the later era. R0 resection was achieved in all patients, and no tumor rupture was documented. Median operative time was 73.5 min, median postoperative length of stay was 7.5 days, and major morbidity occurred in six patients (13.6%). One patient (2.3%) died from sepsis within 30 days after reoperation for a postoperative gastric suture-line leak. Conclusions: Following the introduction of robotic surgery, management of primary gastric GIST evolved toward a more diversified and individualized surgical strategy. Robotic surgery was incorporated as an additional minimally invasive option, while the overall proportion of completed minimally invasive resections remained stable. These findings represent an early institutional experience and do not establish equivalence or comparative superiority among surgical approaches.