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Background <p>The modified age-adjusted Charlson Comorbidity Index (mACCI) is associated with postoperative complications and long-term survival after gastrectomy. However, whether robotic gastrectomy (RG) provides clinical advantages over laparoscopic gastrectomy (LG) in high-risk patients remains unclear. This study evaluated short- and long-term outcomes of RG compared with LG according to mACCI.</p> Methods <p>A total of 1501 patients who underwent minimally invasive gastrectomy for clinical stage I–II gastric cancer between 2012 and 2021 were retrospectively analyzed. Patients were stratified by mACCI (&lt; 4 and ≥ 4), and propensity score matching was performed within each stratum. Short-term outcomes, overall survival (OS), recurrence-free survival (RFS), and cumulative incidence of other-cause and gastric cancer-specific death were assessed.</p> Results <p>Among patients with mACCI ≥ 4, RG was associated with a lower incidence of postoperative complications than LG after matching (2.7% vs. 8.2%, <i>P</i> = 0.036), including pancreatic fistula (0% vs. 3.3%, <i>P</i> = 0.030). RG showed significantly improved OS (HR 0.485, 95% CI 0.271–0.868, <i>P</i> = 0.015) and RFS (HR 0.417, 95% CI 0.236–0.738, <i>P</i> = 0.003). Competing risk analysis demonstrated a lower incidence of other-cause death in the RG group, whereas gastric cancer-specific mortality did not differ. No significant differences were observed between approaches in patients with mACCI &lt; 4.</p> Conclusions <p>Robotic gastrectomy was associated with reduced postoperative complications and improved long-term outcomes in high-risk patients with substantial comorbidities. RG may represent a preferable surgical approach in this population.</p>

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Comparison of long-term outcomes of robotic gastrectomy and laparoscopic gastrectomy using the modified age-adjusted Charlson Comorbidity Index

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Kyota Takahashi,
  • Keiichi Fujiya,
  • Masanori Terashima,
  • Akifumi Notsu,
  • Yusuke Koseki,
  • Kenichiro Furukawa,
  • Yutaka Tanizawa,
  • Etsuro Bando

摘要

Background

The modified age-adjusted Charlson Comorbidity Index (mACCI) is associated with postoperative complications and long-term survival after gastrectomy. However, whether robotic gastrectomy (RG) provides clinical advantages over laparoscopic gastrectomy (LG) in high-risk patients remains unclear. This study evaluated short- and long-term outcomes of RG compared with LG according to mACCI.

Methods

A total of 1501 patients who underwent minimally invasive gastrectomy for clinical stage I–II gastric cancer between 2012 and 2021 were retrospectively analyzed. Patients were stratified by mACCI (< 4 and ≥ 4), and propensity score matching was performed within each stratum. Short-term outcomes, overall survival (OS), recurrence-free survival (RFS), and cumulative incidence of other-cause and gastric cancer-specific death were assessed.

Results

Among patients with mACCI ≥ 4, RG was associated with a lower incidence of postoperative complications than LG after matching (2.7% vs. 8.2%, P = 0.036), including pancreatic fistula (0% vs. 3.3%, P = 0.030). RG showed significantly improved OS (HR 0.485, 95% CI 0.271–0.868, P = 0.015) and RFS (HR 0.417, 95% CI 0.236–0.738, P = 0.003). Competing risk analysis demonstrated a lower incidence of other-cause death in the RG group, whereas gastric cancer-specific mortality did not differ. No significant differences were observed between approaches in patients with mACCI < 4.

Conclusions

Robotic gastrectomy was associated with reduced postoperative complications and improved long-term outcomes in high-risk patients with substantial comorbidities. RG may represent a preferable surgical approach in this population.