Robotic-assisted versus laparoscopic gastrectomy in a low-incidence Nordic country: A single-center retrospective study

Background: Robotic-assisted gastrectomy is increasingly used in the treatment of gastric cancer, but the evidence on outcomes in Western low-volume centers remains limited. We aimed to evaluate the surgical and oncological outcomes during implementation of robotic-assisted gastrectomy in a university hospital in Norway and to compare outcomes with laparoscopic-assisted gastrectomy. Methods: All patients undergoing curative-intent resection for gastric adenocarcinoma at Oslo University Hospital with either robotic-assisted gastrectomy or laparoscopic-assisted gastrectomy from November 2018 to December 2025 were included in this retrospective cohort study. Laparoscopic-assisted gastrectomy was introduced at the center in 2015 and robotic-assisted gastrectomy in 2018. During the study period, two surgeons received training in laparoscopic-assisted gastrectomy, while robotic-assisted gastrectomy was implemented with sequential training of five surgeons. The main outcome was textbook outcome, defined as no serious complications, R0 resection, no conversion to open surgery, at least 15 lymph nodes in the specimen, and no 30-day mortality or readmission. Secondary outcomes included R0 resection, number of lymph nodes, serious complications, anastomotic leakage, procedure time and overall survival. Results: During the study period, there were 136 attempted robotic-assisted gastrectomies and 134 attempted laparoscopic-assisted gastrectomies, of which 108 (79%) and 104 (78%) were completed ( p = 0.72). The overall distribution of tumor location differed between the robotic-assisted gastrectomy and laparoscopic-assisted gastrectomy groups ( p = 0.03). Otherwise, the groups were comparable for the assessed baseline characteristics. Textbook outcome was achieved in 54/108 (50%) robotic-assisted gastrectomy and 55/104 (53%) laparoscopic-assisted gastrectomy procedures ( p = 0.67). Procedure time was 60 min (95% confidence interval: 41, 79) longer in robotic-assisted gastrectomy versus laparoscopic-assisted gastrectomy. R0 resection was observed in 94/108 (87%) patients after robotic-assisted gastrectomy and 100/104 (96%) after laparoscopic-assisted gastrectomy ( p = 0.03). There was no difference in other short-term outcomes or overall survival. Conclusion: Robotic-assisted gastrectomy was associated with a similar textbook outcome rate compared with that of laparoscopic-assisted gastrectomy. The lower rate of R0 resections after robotic-assisted gastrectomy warrants continued audit and further evaluation.