Robot-Assisted Surgery Shows Advantages Over Laparoscopy in Gastric Cancer

Gastric cancer is most often treated with surgery, yet minimally invasive techniques can be technically challenging. Laparoscopic gastrectomy reduces recovery time compared with open surgery but relies on rigid instruments and limited visualization that can amplify tremor. Robotic platforms were introduced to mitigate these constraints. A new nationwide analysis now indicates that robotic gastrectomy offers clinical advantages over conventional laparoscopy in contemporary practice.

Robotic gastrectomy (RG) was evaluated against laparoscopic gastrectomy (LG) by investigators at Fujita Health University–Okazaki Medical Center, Japan, using data from the National Clinical Database. In Japan, RG entered national insurance coverage in 2018 and has since become more widely adopted. The system is designed to provide greater precision, enhanced dexterity, and improved visualization compared with conventional laparoscopy.

The retrospective cohort study identified patients who underwent minimally invasive distal gastrectomy (DG) or total gastrectomy (TG) between January 2023 and December 2024. Propensity score matching produced 9,743 paired RG–LG DG cases and 1,617 paired RG–LG TG cases. The findings were published on May 29, 2026, in Gastric Cancer, with collaborators from Fujita Health University, the University of Tokyo, and Gunma University, supported by the Japanese Gastric Cancer Association.

Operative times were longer with RG. On average, robotic DG required about 50 additional minutes and robotic TG nearly 70 minutes compared with laparoscopy. Despite this, RG reduced blood loss by 33–40%, lowered the likelihood of conversion to open surgery by 50–65%, and shortened postoperative hospital stay for both DG and TG. In DG, RG also decreased serious postoperative complications and intra-abdominal infections. In TG, a significant improvement in the primary outcome of major postoperative complications was not observed.

The analysis suggests outcome gains with RG have strengthened since its introduction into routine care prior to 2018, likely reflecting advances in technology, growing surgical experience, and expanded training opportunities. The authors anticipate further improvements as adoption and proficiency continue to increase.

“RG has become broadly integrated into routine clinical practice across Japan. Under these contemporary conditions, it remains essential to clarify whether RG offers tangible clinical advantages over LG,” said Prof. Susumu Shibasaki, Professor, Department of Surgery, Fujita Health University–Okazaki Medical Center.

“Over the next 5–10 years, these findings are expected to accelerate the widespread adoption of robotic surgery. As a result, more patients will have access to safer, higher quality surgical care, leading to better recovery, fewer complications, and improved overall outcomes,” said Prof. Shibasaki.

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