Robotic versus laparoscopic gastrectomy for localized gastric cancer: Meta-analysis of propensity score-matched studies with the implementation of a novel morbidity index

Localised gastric cancer is potentially curable via minimally invasive radical gastrectomy. Our systematic review assessed the safety and efficacy of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) for localised gastric cancer based on propensity-score matching studies. PubMed, Cochrane, Medline, Embase, Web of science and Scopus were systematically searched for publications before April 2023. We used mean difference for continuous data and risk-ratios for dichotomous data. Random and fixed-effect models were utilized depending on degree of clinical heterogeneity. Additionally, we introduced a novel index as an additional parameter of morbidity to improve the sensitivity and accuracy of intervention effect. 15 PSM studies involving 10,389 patients were included in the final analysis. RG demonstrated significantly lower morbidity in terms of overall complications [RR 0.75 (95 %CI 0.62, 0.91) p = 0.0004], Clavien-Dindo ≥ IIIa morbidity rate [RR 0.71, (95 %CI 0.58, 0.86) p = 0.0007] and intra-abdominal complication (IAC) [RR 0.73 (95 %CI 0.57, 0.94), p = 0.02)]. These findings were further supported by the novel morbidity index. There is no significant difference in mortality rate. RG had longer operation time [MD 36.62, (95 %CI 26.74, 46.51) p < 0.0001], lesser blood loss [MD -16.90 (95 %CI -25.38, −8.42), p < 0.0001)] and higher lymph node yield [MD 1.53 (95 %CI 0.51, 2.55), p = 0.003]. Cost was significantly higher in RG [MD +3295.78 USD (95 %CI 2813.13, 3778.42) p < 0.00001]. Parameters of recovery (i.e. hospital stay) demonstrated no clinical significance. Long-term oncological outcomes were largely comparable. Despite longer operation time and cost, RG is safe and feasible with potential improvements in morbidity and short-term outcomes. Comparative outcomes of robotic vs laparoscopic gastrectomy for gastric cancer. SynopsisOur study highlights the superior performance of robotic gastrectomy in addressing localised gastric cancer. Despite lengthier procedures and higher expenses, it demonstrates improved morbidity (substantiated by a novel morbidity index) and short-term outcomes. Recovery duration and long-term oncological safety remain consistent when compared to laparoscopic surgery.