Robotic Gastrectomy and Delivery of Adjuvant Systemic Therapy in Locally Advanced Gastric Adenocarcinoma: An NCDB Propensity Score-Matched Analysis

Background/Objectives: Completion of perioperative systemic therapy is essential for improving survival in patients with locally advanced gastric adenocarcinoma; however, many patients do not receive planned adjuvant therapy because of surgical complications or inadequate recovery. Robotic gastrectomy may improve postoperative recovery and facilitate adjuvant therapy delivery, but contemporary national data remain limited. This study evaluated the association between surgical approach and adjuvant systemic therapy utilization. Methods: Adults with non-metastatic, locally advanced (>pT2N0 or received neoadjuvant chemotherapy) gastric adenocarcinoma who underwent gastrectomy from 2016 to 2021 were identified from the National Cancer Database. Patients who met the criteria for adjuvant systemic therapy were included. Propensity score matching was performed to compare robotic gastrectomy (RG) with laparoscopic gastrectomy (LG) and open gastrectomy (OG). The primary outcome was receipt of adjuvant systemic therapy (ASTx). The secondary outcomes included days from surgery to ASTx initiation, perioperative outcomes, oncologic quality metrics, and overall survival. Results: Among 5853 eligible patients, 17.8% underwent RG. After propensity score matching, ASTx utilization was similar between RG and LG (43.6% vs. 43.9%, p = 0.946) and between RG and OG (44.5% vs. 48.0%, p = 0.144), with no differences in days from surgery to ASTx initiation. Compared with LG, RG was associated with higher R0 resection rates but higher unplanned 30-day readmission rates. Compared with OG, RG was associated with higher R0 resection rates, greater regional lymph node examination, shorter length of stay, and lower 90-day mortality rates. Overall survival rates did not significantly differ between approaches. Conclusions: In this contemporary national analysis, RG did not result in improved delivery or timing of adjuvant systemic therapy despite favorable perioperative outcomes. These findings suggest that considering surgical approach alone is insufficient to address barriers to completion of multimodality therapy in gastric cancer.