Robotic versus laparoscopic gastrectomy after neoadjuvant chemotherapy in overweight and obese patients with gastric cancer: a propensity score-matched analysis.

PURPOSE: Evidence comparing robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) in overweight and obese patients with gastric cancer after neoadjuvant chemotherapy (NACT) remains limited. This study compared perioperative outcomes in this technically demanding setting. METHODS: We conducted a retrospective single-center study using a prospectively maintained database. Patients with body mass index (BMI) ≥25kg/m² who underwent RG or LG after NACT between January 2018 and December 2022 were reviewed. A total of 91 patients were included in the analysis after matching (47 in the RG group and 44 in the LG group). Intraoperative, postoperative, and oncologic outcomes were compared between the two groups. RESULTS: After matching, RG was associated with shorter operative time (233.6 vs. 276.6min, P=0.003), less blood loss (44.0 vs. 70.8mL, P < 0.001), a greater total lymph node yield (34.3 vs. 30.5, P=0.002) and in the supra-pancreatic area (13.2 vs. 10.6, P = 0.007), faster bowel recovery (3.0 vs. 3.7 days, P < 0.05), earlier liquid intake (3.1 vs 3.9 days, P < 0.05), shorter postoperative stay (7.9 vs. 11.1 days, P < 0.05), and lower overall and surgical morbidity (12.8% vs. 31.8%, P = 0.028; 4.3% vs. 22.7%, P = 0.009). Five-year overall survival (OS) and recurrence-free survival (RFS) was comparable between the groups (both P > 0.05). Site-specific recurrence-free survival analyses also showed no significant between-group differences. CONCLUSIONS: In overweight and obese patients with gastric cancer undergoing gastrectomy after neoadjuvant chemotherapy, RG was associated with improved perioperative outcomes. The robotic approach may be particularly useful when minimally invasive gastrectomy is technically demanding, while long-term oncologic outcomes should be interpreted cautiously.