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<p>To evaluate the learning curve, clinical safety, and 3-year oncological outcomes of robotic distal gastrectomy (RDG) for gastric cancer (GC) during its multi-institutional introduction. We focused on the impact of surgeons who qualified under the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES). We analyzed 251 consecutive patients who underwent RDG for GC at five affiliated institutions. The patients were divided into phases 1 (cases 1–59) and 2 (cases 60–251) based on a cumulative sum (CUSUM)-defined learning curve for operative time. Although the CUSUM analysis identified a statistical transition point at the 59th case, clinical outcomes, including complication rates (phase 1 vs. phase 2; Clavien–Dindo ≥ III: 8.5% vs. 3.1%, <i>P</i> = 0.102), were consistently stable from outset. Although phase 2 included advanced clinical stages (cStage II/III: 15.3% vs. 30.2%, <i>P</i> = 0.035) and older patients (median age: 67 vs. 72 years, <i>P</i> &lt; 0.001), operative times remained stable (median: 340 vs. 331.5&#xa0;min, <i>P</i> = 0.430), and the number of harvested lymph nodes significantly increased (median 33 vs. 37, <i>P</i> = 0.040). Three-year overall (93.1% vs. 93.0%, <i>P</i> = 0.878) and relapse-free (89.6% vs. 91.8%, <i>P</i> = 0.995) survival rates were comparable between the phases. Sub-analysis revealed that JSES ESSQS-qualified colorectal specialists achieved safety profiles comparable with those of gastric specialists, despite longer operative times. RDG can be safely performed without early-phase risk when led by JSES ESSQS-qualified surgeons. Their high baseline proficiency ensures stable clinical safety and favorable oncological outcomes, even as indications expand to complex cases.</p>

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Safety, technical transferability, and oncological outcomes of multi-institutional robotic distal gastrectomy for gastric cancer: impact of surgeons qualified under the endoscopic surgical skill qualification system of the Japan Society for Endoscopic Surgery

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Yuma Ebihara,
  • Noriaki Kyogoku,
  • Hironobu Takano,
  • Hideyuki Wada,
  • Takeo Nitta,
  • Daisuke Saikawa,
  • Yoshiyuki Yamamura,
  • Minoru Takada,
  • Toshiaki Shichinohe,
  • Satoshi Hirano

摘要

To evaluate the learning curve, clinical safety, and 3-year oncological outcomes of robotic distal gastrectomy (RDG) for gastric cancer (GC) during its multi-institutional introduction. We focused on the impact of surgeons who qualified under the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES). We analyzed 251 consecutive patients who underwent RDG for GC at five affiliated institutions. The patients were divided into phases 1 (cases 1–59) and 2 (cases 60–251) based on a cumulative sum (CUSUM)-defined learning curve for operative time. Although the CUSUM analysis identified a statistical transition point at the 59th case, clinical outcomes, including complication rates (phase 1 vs. phase 2; Clavien–Dindo ≥ III: 8.5% vs. 3.1%, P = 0.102), were consistently stable from outset. Although phase 2 included advanced clinical stages (cStage II/III: 15.3% vs. 30.2%, P = 0.035) and older patients (median age: 67 vs. 72 years, P < 0.001), operative times remained stable (median: 340 vs. 331.5 min, P = 0.430), and the number of harvested lymph nodes significantly increased (median 33 vs. 37, P = 0.040). Three-year overall (93.1% vs. 93.0%, P = 0.878) and relapse-free (89.6% vs. 91.8%, P = 0.995) survival rates were comparable between the phases. Sub-analysis revealed that JSES ESSQS-qualified colorectal specialists achieved safety profiles comparable with those of gastric specialists, despite longer operative times. RDG can be safely performed without early-phase risk when led by JSES ESSQS-qualified surgeons. Their high baseline proficiency ensures stable clinical safety and favorable oncological outcomes, even as indications expand to complex cases.