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Background <p>Robotic gastrectomy has emerged as a potential advancement over laparoscopic surgery for gastric cancer, offering enhanced precision through three-dimensional visualization and articulated instrumentation. However, its clinical superiority remains controversial.</p> Methods <p>This review was prospectively registered in the PROSPERO database (ID: CRD420251133133). We conducted a systematic review and meta-analysis of randomized controlled trials comparing robotic gastrectomy (RG) with laparoscopic gastrectomy (LG) for gastric adenocarcinoma. Literature searches across six databases identified eligible RCTs until January 2025. The primary outcomes included operative time, postoperative complications, blood loss, and lymph node harvest. The secondary outcomes included recovery parameters and hospital stay. Evidence certainty was assessed using the GRADE methodology.</p> Results <p>Four RCTs encompassing 919 patients (480 RG, 439 LG) met the inclusion criteria. RG significantly reduced overall postoperative complications (OR 0.49, 95% CI 0.26–0.93, P = 0.03), shortened hospital stay (MD −&#xa0;0.88&#xa0;days, 95% CI −&#xa0;1.21 to −&#xa0;0.55, P &lt; 0.00001), and accelerated bowel function recovery (MD −&#xa0;0.52&#xa0;days, 95% CI −&#xa0;1.00 to −&#xa0;0.05, P = 0.03) and oral intake (MD −&#xa0;0.52&#xa0;days, 95% CI −&#xa0;1.01 to −&#xa0;0.03, P = 0.04). However, operative time was significantly longer (MD + 16.95&#xa0;min, 95% CI 10.93–22.98, P &lt; 0.00001). Severe complications, anastomotic leakage, reoperation rates, blood loss, and lymph node yield were comparable between the approaches. GRADE assessment revealed moderate certainty for hospital stay reduction and low-to-very-low certainty for other outcomes due to heterogeneity and methodological limitations of the studies.</p> Conclusions <p>Across four RCTs conducted in high-volume East Asian centers, robotic gastrectomy demonstrates superior perioperative recovery with reduced overall complications and accelerated rehabilitation compared with laparoscopic surgery, despite longer operative times. Oncological adequacy remains equivalent across approaches. Generalizability to Western case-mix and perioperative pathways remains uncertain.</p>

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Robotic versus laparoscopic gastrectomy for gastric cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials on operative metrics, lymphadenectomy, and postoperative complications

  • 期刊论文

  • 发表日期：

    2025年9月29日

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  • Wajahat Mirza,
  • Yashal Islam Cheema,
  • Hadi Mohammad Khan,
  • Eshan Ahmad,
  • Sundus Dadan,
  • Muhammad Ahmad Nadeem

摘要

Background

Robotic gastrectomy has emerged as a potential advancement over laparoscopic surgery for gastric cancer, offering enhanced precision through three-dimensional visualization and articulated instrumentation. However, its clinical superiority remains controversial.

Methods

This review was prospectively registered in the PROSPERO database (ID: CRD420251133133). We conducted a systematic review and meta-analysis of randomized controlled trials comparing robotic gastrectomy (RG) with laparoscopic gastrectomy (LG) for gastric adenocarcinoma. Literature searches across six databases identified eligible RCTs until January 2025. The primary outcomes included operative time, postoperative complications, blood loss, and lymph node harvest. The secondary outcomes included recovery parameters and hospital stay. Evidence certainty was assessed using the GRADE methodology.

Results

Four RCTs encompassing 919 patients (480 RG, 439 LG) met the inclusion criteria. RG significantly reduced overall postoperative complications (OR 0.49, 95% CI 0.26–0.93, P = 0.03), shortened hospital stay (MD − 0.88 days, 95% CI − 1.21 to − 0.55, P < 0.00001), and accelerated bowel function recovery (MD − 0.52 days, 95% CI − 1.00 to − 0.05, P = 0.03) and oral intake (MD − 0.52 days, 95% CI − 1.01 to − 0.03, P = 0.04). However, operative time was significantly longer (MD + 16.95 min, 95% CI 10.93–22.98, P < 0.00001). Severe complications, anastomotic leakage, reoperation rates, blood loss, and lymph node yield were comparable between the approaches. GRADE assessment revealed moderate certainty for hospital stay reduction and low-to-very-low certainty for other outcomes due to heterogeneity and methodological limitations of the studies.

Conclusions

Across four RCTs conducted in high-volume East Asian centers, robotic gastrectomy demonstrates superior perioperative recovery with reduced overall complications and accelerated rehabilitation compared with laparoscopic surgery, despite longer operative times. Oncological adequacy remains equivalent across approaches. Generalizability to Western case-mix and perioperative pathways remains uncertain.