Enhanced recovery and reduced opioid requirements following robot-assisted minimally invasive gastrectomy: a retrospective cohort study

Gastric cancer requires surgical resection for cure, with robot-assisted minimally invasive gastrectomy (RAMIG) emerging as an alternative to open gastrectomy (OG). Comparative data on postoperative pain and recovery remain limited. This study aimed to compare RAMIG versus OG in patients with resectable gastric cancer, focusing on postoperative opioid consumption, pain intensity, and recovery parameters. In this retrospective cohort study, 138 patients with resectable gastric cancer underwent either RAMIG (n = 39) or OG (n = 99) between May 2021 and August 2023. Primary endpoints were pain intensity (Numerical Rating Scale (NRS)) and opioid consumption. Secondary endpoints comprised intensive/intermediate care (ICU/IMC) and hospital stays, blood loss, severe complications, and operative duration. Statistical analysis used SPSS version 29.0 with Mann-Whitney U and Fisher's exact tests (p < 0.05). RAMIG showed reduced opioid consumption (p = 0.002) and lower NRS scores during mobilization on days 5 and 7 (p = 0.011; p = 0.002) and at rest on day 7 (p = 0.005). The RAMIG group experienced significantly shortened ICU/IMC stays (p < 0.001), reduced hospitalization duration (p < 0.001), and decreased intraoperative blood loss, although operative duration was prolonged. RAMIG demonstrates favorable outcomes regarding opioid requirements, pain management, ICU/IMC and hospital stays, and blood loss compared to OG, despite longer operative duration. These findings support RAMIG as an effective approach enabling accelerated recovery in patient-centered care, though prospective randomized validation studies are warranted. Trial registration: DRKS00036368, retrospectively registered 11th of March 2025.