Robotic gastrectomy linked to fewer complications and less blood loss than laparoscopic surgery in Japanese study

Researchers from Fujita Health University and collaborating institutions analyzed data from Japan's National Clinical Database to compare robotic and laparoscopic gastrectomy for gastric cancer. The study examined patients who underwent minimally invasive distal or total gastrectomy between January 2023 and December 2024, using propensity score matching to create 9,743 matched pairs for distal gastrectomy and 1,617 matched pairs for total gastrectomy.

Robotic procedures consistently required longer operating times, averaging approximately 50 minutes more for distal gastrectomy and nearly 70 minutes more for total gastrectomy compared with laparoscopic surgery. Despite the longer duration, robotic surgery was associated with 33–40% less blood loss and a 50–65% lower likelihood of conversion to open surgery across both procedure types.

Patients undergoing robotic distal gastrectomy experienced fewer serious postoperative complications and intra-abdominal infections, along with shorter hospital stays, compared with those receiving laparoscopic distal gastrectomy. For total gastrectomy, robotic surgery also reduced blood loss, conversion rates, and hospital stay, but did not show a significant reduction in major postoperative complications.

The researchers noted that the absolute differences in outcomes were small but consistent across multiple perioperative measures. Professor Susumu Shibasaki, who led the study, stated that the findings suggest robotic gastrectomy may achieve a level of minimal invasiveness beyond conventional laparoscopic surgery, which is itself a highly refined approach.

Compared with an earlier nationwide study conducted before robotic surgery received national insurance coverage in Japan in 2018, the current analysis found improved outcomes following robotic procedures. The researchers attribute this to ongoing advances in robotic technology, greater surgical experience, and expanded training opportunities over the past several years.

The study highlights that total gastrectomy remains more technically demanding and is performed less frequently, which may limit surgeons' opportunities to gain proficiency with robotic techniques. This could explain why the reduction in major complications was not observed for total gastrectomy as it was for distal gastrectomy.

The findings were published in the journal Gastric Cancer and supported by the Japanese Gastric Cancer Association. The researchers anticipate that continued technological innovation and broader adoption of robotic surgery will further improve outcomes for gastric cancer patients over the next five to ten years.