Short-Term Clinical Outcomes After Laparoscopic and Robotic Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis



The different advantages of laparoscopic gastrectomy (LG) and robotic gastrectomy (RG), two new minimally invasive surgical techniques for gastric cancer, remain controversial.


To compare the short-term clinical outcomes of LG and RG.


A retrospective, single-center comparative study of 1044 patients (LG = 750, RG = 294) was conducted. Patients undergoing LG and RG were matched (2:1 ratio) according to sex, age, BMI, extent of gastric resection, and pathologic stage. The primary outcomes were morbidity and mortality and perioperative recovery parameters; major types of complications were also analyzed.


After matching, 798 patients (LG = 532, RG = 266) were included. Both the LG and RG groups showed similar overall complication rates (LG = 12.8% vs RG = 12.4%) and operative mortality (LG = 0.4% vs RG = 0.4%). Compared to those who underwent LG, patients undergoing RG had significantly longer operative times (236.92 ± 57.28 vs 217.77 ± 65.00 min, p < 0.001), higher total costs (US$16,241.42 vs US$12,497, p < 0.001), less operative blood loss (77.07 ± 64.37 vs 103.68 ± 86.92 ml, p < 0.001), higher numbers of retrieved lymph nodes (32.0 vs 29.9, p < 0.001), and higher rates of retrieving more than 16 lymph nodes (94.0 vs 85.5%; p < 0.001). No significant differences between groups were noted in terms of the rate of reoperation, time until a soft diet was consumed, or length of hospital stay. The major complication and readmission rates were similar in both groups.


RG and LG produced similar short-term clinical outcomes, indicating that RG is a safe and beneficial surgical procedure.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a Cancer Journal for Clinicians 2015;65(2):87–108.

    Article  Google Scholar 

  2. 2.

    Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F et al. Cancer statistics in China, 2015. CA: a Cancer Journal for Clinicians 2016;66(2):115–32.

    Article  Google Scholar 

  3. 3.

    Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surgical Laparoscopy & Endoscopy 1994;4(2):146–8.

    CAS  Google Scholar 

  4. 4.

    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Annals of Surgery 2008;248(5):721–7.

    Article  PubMed  Google Scholar 

  5. 5.

    Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surgical Endoscopy 2009;23(8):1759–63.

    Article  PubMed  Google Scholar 

  6. 6.

    Nakauchi M, Suda K, Kadoya S, Inaba K, Ishida Y, Uyama I. Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surgical Endoscopy 2016;30(10):4632–9.

    Article  PubMed  Google Scholar 

  7. 7.

    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Annals of Surgery 2010;251(3):417–20.

    Article  PubMed  Google Scholar 

  8. 8.

    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Annals of Surgery 2007;245(1):68–72.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW et al. Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma. Annals of Surgery 2016;263(1):103–9.

    Article  PubMed  Google Scholar 

  10. 10.

    Suda K, Man IM, Ishida Y, Kawamura Y, Satoh S, Uyama I. Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surgical Endoscopy 2015;29(3):673–85.

    Article  PubMed  Google Scholar 

  11. 11.

    Kim YW, Reim D, Park JY, Eom BW, Kook MC, Ryu KW et al. Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surgical Endoscopy 2016;30(4):1547–52.

    Article  PubMed  Google Scholar 

  12. 12.

    Kim KM, An JY, Kim HI, Cheong JH, Hyung WJ, Noh SH. Major early complications following open, laparoscopic and robotic gastrectomy. The British Journal of Surgery 2012;99(12):1681–7.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han SU. Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: The Learning Curve of Robotic Surgery. Journal of Gastric Cancer 2012;12(3):156–63.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2011;14(2):113–23.

  15. 15.

    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of Surgical Oncology 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  16. 16.

    Son T, Hyung WJ, Lee JH, Kim YM, Kim HI, An JY et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer 2012;118(19):4687–93.

    Article  PubMed  Google Scholar 

  17. 17.

    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al. The Clavien-Dindo classification of surgical complications: five-year experience. Annals of Surgery 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  18. 18.

    Schmidt B, Chang KK, Maduekwe UN, Look-Hong N, Rattner DW, Lauwers GY et al. D2 lymphadenectomy with surgical ex vivo dissection into node stations for gastric adenocarcinoma can be performed safely in Western patients and ensures optimal staging. Annals of Surgical Oncology 2013;20(9):2991–9.

    Article  PubMed  Google Scholar 

  19. 19.

    White I, Greenberg R, Itah R, Inbar R, Schneebaum S, Avital S. Impact of conversion on short and long-term outcome in laparoscopic resection of curable colorectal cancer. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2011;15(2):182–7.

    Article  PubMed  Google Scholar 

  20. 20.

    Yang SY, Roh KH, Kim YN, Cho M, Lim SH, Son T et al. Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer. Annals of Surgical Oncology 2017;24(7):1770–7.

    Article  Google Scholar 

  21. 21.

    Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. The Lancet Oncology 2006;7(4):309–15.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Hashizume M, Sugimachi K. Robot-assisted gastric surgery. The Surgical clinics of North America 2003;83(6):1429–44.

    Article  PubMed  Google Scholar 

  23. 23.

    Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Buchler MW. Robot-assisted abdominal surgery. The British Journal of Surgery 2004;91(11):1390–7.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Shen W, Xi H, Wei B, Cui J, Bian S, Zhang K et al. Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surgical Endoscopy 2016;30(2):574–80.

    Article  PubMed  Google Scholar 

  25. 25.

    Park JY, Ryu KW, Reim D, Eom BW, Yoon HM, Rho JY et al. Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy? World Journal of Surgery 2015;39(7):1789–97.

    Article  PubMed  Google Scholar 

  26. 26.

    Son T, Lee JH, Kim YM, Kim HI, Noh SH, Hyung WJ. Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surgical Endoscopy 2014;28(9):2606–15.

    Article  PubMed  Google Scholar 

  27. 27.

    Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surgical Endoscopy 2014;28(6):1779–87.

    Article  PubMed  Google Scholar 

  28. 28.

    Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC et al. Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2012;16(7):1303–10.

    Article  Google Scholar 

  29. 29.

    Hyung WJ, Noh SH, Shin DW, Huh J, Huh BJ, Choi SH et al. Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer. Annals of Surgical Oncology 2002;9(1):5–12.

    Article  Google Scholar 

  30. 30.

    Han TS, Kong SH, Lee HJ, Ahn HS, Hur K, Yu J et al. Dissemination of free cancer cells from the gastric lumen and from perigastric lymphovascular pedicles during radical gastric cancer surgery. Annals of Surgical Oncology 2011;18(10):2818–25.

    Article  PubMed  Google Scholar 

  31. 31.

    Lee J, Kim YM, Woo Y, Obama K, Noh SH, Hyung WJ. Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surgical Endoscopy 2015;29(11):3251–60.

    Article  PubMed  Google Scholar 

  32. 32.

    Hyun MH, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH et al. Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Annals of Surgical Oncology 2013;20(4):1258–65.

    Article  PubMed  Google Scholar 

  33. 33.

    Jin LX, Sanford DE, Squires MH, 3rd, Moses LE, Yan Y, Poultsides GA et al. Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative. Annals of Surgical Oncology 2016;23(8):2398–408.

    Article  PubMed  Google Scholar 

  34. 34.

    Acher AW, Squires MH, Fields RC, Poultsides GA, Schmidt C, Votanopoulos KI et al. Readmission Following Gastric Cancer Resection: Risk Factors and Survival. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2016;20(7):1284–94.

    Article  Google Scholar 

  35. 35.

    Sah BK, Chen MM, Yan M, Zhu ZG. Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital. World Journal of Gastroenterology 2010;16(1):98–103.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Alleblas CCJ, de Man AM, van den Haak L, Vierhout ME, Jansen FW, Nieboer TE. Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review. Annals of Surgery 2017;266(6):905–20.

    Article  PubMed  Google Scholar 

  37. 37.

    Tarr ME, Brancato SJ, Cunkelman JA, Polcari A, Nutter B, Kenton K. Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. Journal of Minimally Invasive Gynecology 2015;22(2):234–8.

    Article  PubMed  Google Scholar 

  38. 38.

    Dalager T, Sogaard K, Bech KT, Mogensen O, Jensen PT. Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review. Surgical Endoscopy 2017;31(2):516–26.

    Article  Google Scholar 

  39. 39.

    Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surgical Endoscopy 2009;23(6):1204–11.

    Article  PubMed  Google Scholar 

  40. 40.

    Heemskerk J, van Gemert WG, de Vries J, Greve J, Bouvy ND. Learning curves of robot-assisted laparoscopic surgery compared with conventional laparoscopic surgery: an experimental study evaluating skill acquisition of robot-assisted laparoscopic tasks compared with conventional laparoscopic tasks in inexperienced users. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2007;17(3):171–4.

    Article  Google Scholar 

  41. 41.

    Park SS, Kim MC, Park MS, Hyung WJ. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surgical Endoscopy 2012;26(1):60–7.

    Article  PubMed  Google Scholar 

  42. 42.

    Kim HI, Park MS, Song KJ, Woo Y, Hyung WJ. Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2014;40(10):1346–54.

    Article  Google Scholar 

  43. 43.

    Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Li AF et al. Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS One 2014;9(10):e111499.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Annals of Surgery 2009;249(6):927–32.

    Article  PubMed  Google Scholar 

  45. 45.

    Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, Cho YK et al. Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surgical Endoscopy 2007;21(1):28–33.

    Article  PubMed  Google Scholar 

Download references


This work was supported by National Natural Science Foundation of China (grant 81270449 and 81572314), Natural Science Foundation of Shandong Provincial, China (grant ZR2012HM046), Key Research and Development Program of Shandong Province, China (grant 2016GGB01022), Qingdao Minsheng Science and Technology Foundation, Shandong, China (grant 14-2-3-5-nsh) and the Qingdao Science and Technology Plan Project (grant 13-1-4-220-jch).

Author information




Ying Kong and Yanbing Zhou were involved in the concept, design, data acquisition, analysis and interpretation, and production of figures and tables and wrote the first draft and revised it critically in light of comments from other authors. Shougen Cao, Liankai Wang, Xiaodong Liu and Zequn Li were involved in the conception, interpretation, manuscript revision, and discussion. Cunlong Lu, Houxin Zhu and Shuai Shen were involved in data acquisition and literature review. All the authors approved the final version submitted. The authors would like to thank American Journal Experts for the help with the editing of this manuscript.

Corresponding author

Correspondence to Yanbing Zhou.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Short-term outcomes after laparoscopic and robotic gastrectomy for gastric cancer

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kong, Y., Cao, S., Liu, X. et al. Short-Term Clinical Outcomes After Laparoscopic and Robotic Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis. J Gastrointest Surg 24, 531–539 (2020).

Download citation


  • Short-term clinical outcomes
  • Laparoscopic gastrectomy
  • Robotic gastrectomy
  • Gastric cancer