Comparative Analysis of Short- and Long-Term Surgical Outcomes Following Open Conversion from Laparoscopic and Robotic Gastrectomy in Patients with Gastric Cancer.

Background/Objective: Laparoscopic gastrectomy (LG) and robotic gastrectomy (RG) exhibit similar surgical outcomes in patients with gastric cancer (GC), except for the higher cost associated with RG. Comparative surgical outcome studies after open conversion from laparoscopic (OL) and robotic (OR) gastrectomy in GC are limited. This study aimed to evaluate clinical effectiveness while considering differences in procedural cost. Methods: This retrospective cohort study included a comparative analysis of patients with GC who underwent OL or OR. Inclusion criteria were histologically confirmed adenocarcinoma and curative resection for GC using OL or OR. Exclusion criteria included initially planned open surgery and other laparoscopic or robotic procedures without gastrectomy. Clinicopathological characteristics, as well as short- and long-term surgical outcomes, were compared between groups. Results: Overall, 118 (1.9%) of 6336 LG cases and 10 (2.6%) of 384 RG cases were included (p = 0.3308). Clinicopathological characteristics were statistically comparable between groups. Postoperative complication incidence, evaluated using the Clavien-Dindo classification, was 19.5% and 10% in the OL and OR groups, respectively (p > 0.05). The median hospital stay was 8 and 9.5 days in the OL and OR groups, respectively (p > 0.05). Reasons for open conversion were similar between groups and included adhesion, bleeding, advanced disease, and positive resection margins, among others. Overall 5-year survival was 0.79 (0.72-0.88) and 0.88 (0.67-1.0) in OL and OR, respectively (p = 0.596). Conclusions: Short- and long-term surgical outcomes after OL and OR did not differ statistically. Selection of LG versus RG should be performed with caution.