Comparison of textbook outcomes and postoperative pain trajectories between reduced-port and conventional robotic distal gastrectomy: a cumulative sum (CUSUM)-adjusted propensity score-matched analysis

To compare textbook outcome (TO) and postoperative pain trajectories between reduced-port robotic distal gastrectomy (rpRDG) and conventional robotic distal gastrectomy (cRDG) for gastric cancer (GC). This retrospective cohort study analyzed patients who underwent robotic distal gastrectomy for GC between September 2022 and March 2026 at a single tertiary center. Cumulative sum (CUSUM) analysis was applied to exclude 30 cases representing the initial learning curve, yielding 107 patients (cRDG, n = 60; rpRDG, n = 47). Following 1:1 propensity score matching (PSM), 39 matched pairs were analyzed. The primary endpoint was TO achievement; secondary endpoints included operative time, estimated blood loss (EBL), retrieved lymph nodes, and postoperative pain assessed by numeric rating scale (NRS) from postoperative day (POD) 1 to 3. The two groups were well-balanced after PSM (all absolute standardized mean differences < 0.1). TO achievement rates were comparable between groups (cRDG: 79.49% vs. rpRDG: 87.18%, p = 0.3621), with no significant differences in operative time (264.97 vs. 246.23 min, p = 0.0808), EBL (47.05 vs. 43.21mL, p = 0.7088), or retrieved lymph nodes (34.67 vs. 38.92, p = 0.2686). A linear mixed-effects model revealed a significant group-by-time interaction in pain scores (p = 0.0044), and the rpRDG group reported significantly lower NRS scores on POD 1 (2.62 vs. 3.13, p = 0.0155). rpRDG demonstrated comparable surgical and oncologic outcomes to cRDG, with statistically significant reduction in early postoperative pain on POD 1, representing a meaningful marginal gain within an ERAS-optimized setting. These findings support rpRDG as a feasible, patient-centered alternative warranting further multicenter validation.