In the evolving landscape of oncologic surgery, the comparison between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for treating advanced gastric cancer has garnered substantial attention. Recent advancements in robotic surgical systems promise enhanced precision, dexterity, and visualization, especially post-neoadjuvant therapy, which aims to reduce tumor burden before surgery. However, the tangible benefits of RG over traditional LG remain under rigorous scientific scrutiny. A newly published systematic review and meta-analysis appearing in BMC Cancer delves deeply into this debate, evaluating the short-term clinical outcomes of these two minimally invasive techniques in patients receiving neoadjuvant therapy for advanced gastric cancer.
The comprehensive study meticulously searched multiple research databases including PubMed, Embase, Web of Science, Cochrane Library, and the Chinese National Knowledge Infrastructure (CNKI), aggregating evidence up to May 10, 2025. Four non-randomized controlled trials, all stemming from East Asian medical centers—where gastric cancer incidence rates are significantly higher—were integrated into this analysis. These studies collectively represented a cohort of 569 patients whose postoperative results were critically examined to discern the comparative efficacy and safety profiles of RG and LG.
Central to the investigation was a multifaceted assessment of surgical outcomes that directly impact patient recovery and long-term prognosis. Variables such as operative time, blood loss, number of lymph nodes dissected, length of hospital stay, postoperative complications, and key recovery milestones like the time to first flatus and initial oral intake were thoroughly scrutinized. The inclusion of re-admission and reoperation rates within 30 days post-surgery served as important measures for evaluating the safety and durability of the surgical approaches.
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One of the seminal findings from the pooled data is the significantly longer operative time observed in robotic gastrectomy compared to laparoscopic surgery, with an average increase exceeding 80 minutes. While extended surgical duration often raises concerns regarding intraoperative risks and resource utilization, this must be interpreted within the context of robotic technology’s inherent complexity, setup time, and learning curve. This nuance highlights the trade-off between surgical precision and procedural expedience.
Intriguingly, despite the prolonged surgeries, RG demonstrated pronounced advantages in accelerating patient recovery. Patients undergoing RG experienced significantly shorter intervals before passing the first flatus, a critical indicator of regained gastrointestinal motility, generally occurring about half a day earlier compared to their LG counterparts. Additionally, these patients initiated liquid diets substantially sooner, suggesting an expedited return of digestive functions. This accelerated recovery could translate into improved patient comfort and potentially shorter or more efficient hospitalization, although hospital stay length did not demonstrate statistically significant differences between the two groups.
Another dimension where robotic surgery showed superiority was in lymphadenectomy quality. The meta-analysis revealed that RG was associated with a higher number of dissected lymph nodes compared to LG. Given that meticulous lymph node removal is crucial for accurate cancer staging and potentially impacts oncological outcomes, this finding underscores the potential oncologic thoroughness afforded by the robotic approach. Enhanced three-dimensional visualization and instrument articulation in robotic systems likely facilitate more precise dissections around critical vascular and lymphatic structures.
When examining the safety profile, the study found no significant differences in blood loss between RG and LG. This suggests that, despite the technical differences, both modalities maintain hemostatic control to similar degrees during surgery. Furthermore, the rates of postoperative complications, encompassing a spectrum from minor to severe, did not differ significantly. This parity extends to the need for surgical conversions from minimally invasive techniques to open procedures, as well as rates of reoperation and hospital readmission within 30 days, indicating comparable perioperative risk profiles.
However, it is vital to consider the heterogeneity in some outcome measures. For instance, analyses of postoperative complications exhibited moderate statistical inconsistency among studies, which might reflect variance in surgical expertise, patient selection, or institutional protocols across the included trials. Therefore, while overarching conclusions favor the potential of robotic surgery, individual patient factors and surgical team experience must guide clinical decision-making.
The methodological rigor of the meta-analysis merits emphasis. Although constrained to four non-randomized controlled trials, the study employed robust statistical techniques to pool continuous and dichotomous variables, ensuring reliability of combined estimates. The geographic focus on East Asian populations—where gastric cancer is more prevalent and neoadjuvant therapy widely adopted—provides contextually relevant data but may limit generalizability to Western cohorts where demographic characteristics and cancer biology differ.
From a technical vantage point, the prolonged operative time in RG primarily derives from system docking, intraoperative instrument exchanges, and the precision-oriented dissection process. Nevertheless, as surgeon experience with robotic platforms accumulates and technological refinements emerge, operative durations are anticipated to decline. Simultaneously, the quicker postoperative recovery markers observed may reflect less tissue trauma and more refined manipulation enabled by robotic arms and high-definition imaging, which reduce inadvertent collateral damage and enhance surgical ergonomics.
The nuanced advantages in lymph node yield also raise questions about standardizing surgical quality metrics. Given that nodal clearance influences staging accuracy and could impact adjuvant treatment decisions, robotic systems may support superior oncological surgery paradigms. However, randomized controlled trials with long-term follow-up are necessary to confirm whether these early technical benefits translate into improved survival outcomes.
This comprehensive synthesis sets a pivotal precedent for the future trajectory of minimally invasive gastric cancer surgery. It underscores that, while robotic gastrectomy currently demands longer operating room time, it simultaneously facilitates improvements in early gastrointestinal recovery and nodal dissection without increasing surgical risks. For surgeons and oncologists, these insights provide a critical evidence base to refine patient counseling, surgical planning, and institutional investment in robotic platforms.
Moreover, this analysis catalyzes further research, highlighting the imperative for large-scale, prospective, randomized studies to definitively establish the oncologic and functional superiority of robotic surgery over conventional laparoscopy. Future investigations should also evaluate cost-effectiveness, patients’ quality of life measures, and technical innovations that may alleviate the current drawbacks of robotic systems.
In conclusion, as gastric cancer treatment evolves toward tailored multimodal regimens, integrating advanced surgical technologies like robotic systems post-neoadjuvant therapy appears promising. This meta-analysis elucidates that robotic gastrectomy is not merely a technological novelty but holds substantive clinical advantages in short-term recovery markers and lymphadenectomy quality. These encouraging findings signify a potential paradigm shift toward broader adoption of robotic surgery in high-risk gastric cancer cases, provided ongoing research continues to validate its long-term benefits and accessibility.
The published work ultimately contributes a critical piece to the dynamic puzzle of optimizing surgical care for gastric cancer, an area where each marginal gain in recovery and oncological precision profoundly impacts patient survival and well-being worldwide. As the surgical oncology community digests these findings, the reframing of robotic gastrectomy from experimental to evidence-based practice may accelerate, ushering in a new era of patient-centric, technology-driven cancer care.
Subject of Research: Comparison of short-term clinical outcomes between robotic gastrectomy and laparoscopic gastrectomy for advanced gastric cancer following neoadjuvant therapy
Article Title: Short-term outcomes of robotic vs. laparoscopic surgery for gastric cancer after neoadjuvant therapy: a systematic review and meta-analysis
Article References:
Tuohuti, T., Abulizi, K. & Li, T. Short-term outcomes of robotic vs. laparoscopic surgery for gastric cancer after neoadjuvant therapy: a systematic review and meta-analysis. BMC Cancer 25, 1002 (2025). https://doi.org/10.1186/s12885-025-14395-3
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14395-3
Tags: advancements in surgical technology for cancer treatmentcomparative study of surgical techniquesEast Asian gastric cancer treatmentminimally invasive surgery for advanced gastric cancerneoadjuvant therapy impact on surgeryoutcomes of robotic surgery in gastric cancerpatient recovery in oncologic surgeryprecision in robotic surgical systemsrobotic gastrectomy vs laparoscopic gastrectomysafety profiles of robotic and laparoscopic surgeryshort-term clinical outcomes in surgerysystematic review of surgical methods