{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T03:07:50Z","timestamp":1779246470644,"version":"3.51.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Robot-assisted gastrectomy has been increasingly adopted as a standard of care, but comparative evidence in Western cohorts remains limited, particularly for total gastrectomy, where esophagojejunostomy and D2 lymphadenectomy are technically demanding. The aim of this study was to compare short-term outcomes after robot-assisted and laparoscopic total gastrectomy at a European high-volume tertiary referral center. This retrospective single-center cohort study included all patients undergoing minimally invasive total gastrectomy (laparoscopic or robot-assisted) for gastric cancer or prophylaxis in CDH1-mutated patients at Karolinska University Hospital (Stockholm, Sweden) from 1 January 2015 to 31 August 2025. The primary outcome was any postoperative complication within 30 days. Secondary outcomes included anastomotic leak, intraoperative blood loss, severe complications (Clavien\u2013Dindo grade\u2009\u2265\u20093), length of stay (LOS), lymph node yield, and 90-day mortality. In total, 156 patients were included (robot-assisted, n=58; laparoscopic, n=98). Any complication occurred in 37.9% after robot-assisted surgery and 68.4% after laparoscopic surgery (P&lt;0.001). Anastomotic leak occurred in 10.3% and 6.1%, respectively (P=0.364). Median blood loss was lower with robot-assisted surgery (50 vs 125 mL, P&lt;0.001). Median LOS, lymph node yield, and 90-day mortality were comparable between groups. In multivariable analyses, robot-assisted surgery was associated with significantly lower odds of any complication (adjusted OR 0.22, 95% CI 0.08\u20130.56;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.002). There were no statistically significant differences between groups regarding anastomotic leak (adjusted OR 0.73, 95% CI 0.10\u20135.54;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.761) or severe complications (adjusted OR 0.95, 95% CI 0.32\u20132.87;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.933). In this Western single-center cohort from a high-volume tertiary referral center, robot-assisted total gastrectomy demonstrated reduced postoperative morbidity to laparoscopic surgery and was associated with reduced intraoperative blood loss.\n                  <\/jats:p>","DOI":"10.1007\/s11701-026-03451-0","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T02:38:29Z","timestamp":1779244709000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robot-assisted versus laparoscopic total gastrectomy: a western high-volume tertiary referral center experience"],"prefix":"10.1007","volume":"20","author":[{"given":"Jonas","family":"Sanberg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo J.","family":"Noordman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mats","family":"Lindblad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Klevebro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Rouvelas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"3451_CR1","doi-asserted-by":"publisher","unstructured":"Japanese Gastric Cancer Treatment Guidelines (2021) (6th edition). Gastric Cancer. 2023;26(1):1\u201325. https:\/\/doi.org\/10.1007\/s10120-022-01331-8","DOI":"10.1007\/s10120-022-01331-8"},{"issue":"10","key":"3451_CR2","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1016\/j.annonc.2022.07.004","volume":"33","author":"F Lordick","year":"2022","unstructured":"Lordick F, Carneiro F, Cascinu S, Fleitas T, Haustermans K, Piessen G et al (2022) Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 33(10):1005\u20131020. https:\/\/doi.org\/10.1016\/j.annonc.2022.07.004","journal-title":"Ann Oncol"},{"issue":"2","key":"3451_CR3","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1002\/bjs.9345","volume":"101","author":"M Degiuli","year":"2014","unstructured":"Degiuli M, Sasako M, Ponti A, Vendrame A, Tomatis M, Mazza C et al (2014) Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. J Br Surg 101(2):23\u201331. https:\/\/doi.org\/10.1002\/bjs.9345","journal-title":"J Br Surg"},{"issue":"5","key":"3451_CR4","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1097\/SLA.0000000000002391","volume":"266","author":"HJF Brenkman","year":"2017","unstructured":"Brenkman HJF, Gisbertz SS, Slaman AE, Goense L, Ruurda JP, van Berge Henegouwen MI et al (2017) Postoperative Outcomes of Minimally Invasive Gastrectomy Versus Open Gastrectomy During the Early Introduction of Minimally Invasive Gastrectomy in the Netherlands. Ann Surg 266(5):831\u2013838. https:\/\/doi.org\/10.1097\/SLA.0000000000002391","journal-title":"Ann Surg"},{"issue":"5","key":"3451_CR5","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1007\/s00464-012-2661-1","volume":"27","author":"L Haverkamp","year":"2013","unstructured":"Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R (2013) Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27(5):1509\u20131520. https:\/\/doi.org\/10.1007\/s00464-012-2661-1","journal-title":"Surg Endosc"},{"issue":"1","key":"3451_CR6","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/SLA.0000000000001249","volume":"263","author":"HI Kim","year":"2016","unstructured":"Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW et al (2016) Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma. Ann Surg 263(1):103\u2013109. https:\/\/doi.org\/10.1097\/SLA.0000000000001249","journal-title":"Ann Surg"},{"issue":"4","key":"3451_CR7","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1002\/jso.27651","volume":"130","author":"AR Dias","year":"2024","unstructured":"Dias AR, Pereira MA, Ramos MFKP, de Oliveira RJ, Yagi OK, Ribeiro U (2024) Robotic versus laparoscopic gastrectomy for gastric cancer: A Western propensity score matched analysis. J Surg Oncol 130(4):714\u2013723. https:\/\/doi.org\/10.1002\/jso.27651","journal-title":"J Surg Oncol"},{"issue":"1","key":"3451_CR8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa055531","volume":"355","author":"D Cunningham","year":"2006","unstructured":"Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJH, Nicolson M et al (2006) Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. N Engl J Med 355(1):11\u201320. https:\/\/doi.org\/10.1056\/NEJMoa055531","journal-title":"N Engl J Med"},{"issue":"10184","key":"3451_CR9","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.1016\/S0140-6736(18)32557-1","volume":"393","author":"SE Al-Batran","year":"2019","unstructured":"Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S et al (2019) Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2\/3 trial. Lancet 393(10184):1948\u20131957. https:\/\/doi.org\/10.1016\/S0140-6736(18)32557-1","journal-title":"Lancet"},{"issue":"8","key":"3451_CR10","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1089\/lap.2023.0136","volume":"33","author":"P Loureiro","year":"2023","unstructured":"Loureiro P, Barbosa JP, Vale JF, Barbosa J (2023) Laparoscopic Versus Robotic Gastric Cancer Surgery: Short-Term Outcomes\u2013Systematic Review and Meta-Analysis of 25,521 Patients. J Laparoendosc Adv Surg Tech 33(8):782\u2013800. https:\/\/doi.org\/10.1089\/lap.2023.0136","journal-title":"J Laparoendosc Adv Surg Tech"},{"key":"3451_CR11","doi-asserted-by":"publisher","unstructured":"Baral S, Arawker MH, Sun Q, Jiang M, Wang L, Wang Y et al (2022) Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: A Mega Meta-Analysis. Front Surg 9. https:\/\/doi.org\/10.3389\/fsurg.2022.895976","DOI":"10.3389\/fsurg.2022.895976"},{"issue":"6","key":"3451_CR12","doi-asserted-by":"publisher","first-page":"834","DOI":"10.3390\/medicina58060834","volume":"58","author":"M Zizzo","year":"2022","unstructured":"Zizzo M, Zanelli M, Sanguedolce F, Torricelli F, Morini A, Tumiati D et al (2022) Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review. Med (B Aires) 58(6):834. https:\/\/doi.org\/10.3390\/medicina58060834","journal-title":"Med (B Aires)"},{"issue":"12","key":"3451_CR13","doi-asserted-by":"publisher","first-page":"108706","DOI":"10.1016\/j.ejso.2024.108706","volume":"50","author":"H Nagata","year":"2024","unstructured":"Nagata H, Kinoshita T, Komatsu M, Habu T, Yoshida M, Yura M (2024) Comparison of robotic versus laparoscopic total gastrectomy for gastric cancer: A single-center retrospective cohort study in a Japanese high-volume center. Eur J Surg Oncol 50(12):108706. https:\/\/doi.org\/10.1016\/j.ejso.2024.108706","journal-title":"Eur J Surg Oncol"},{"issue":"2","key":"3451_CR14","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of Surgical Complications. Ann Surg 240(2):205\u2013213. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"issue":"1","key":"3451_CR15","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12893-020-00812-w","volume":"20","author":"A Tsekrekos","year":"2020","unstructured":"Tsekrekos A, Triantafyllou T, Klevebro F, Hayami M, Lindblad M, Nilsson M et al (2020) Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center. BMC Surg 20(1):157. https:\/\/doi.org\/10.1186\/s12893-020-00812-wPubMed PMID: 32677942","journal-title":"BMC Surg"},{"issue":"6","key":"3451_CR16","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","volume":"173","author":"H Quan","year":"2011","unstructured":"Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676\u2013682. https:\/\/doi.org\/10.1093\/aje\/kwq433PubMed PMID: 21330339","journal-title":"Am J Epidemiol"},{"issue":"2","key":"3451_CR17","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s10120-016-0601-9","volume":"20","author":"T Sano","year":"2017","unstructured":"Sano T, Coit DG, Kim HH, Roviello F, Kassab P, Wittekind C et al (2017) Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer 20(2):217\u2013225. https:\/\/doi.org\/10.1007\/s10120-016-0601-9PubMed PMID: 26897166","journal-title":"Gastric Cancer"},{"issue":"9","key":"3451_CR18","doi-asserted-by":"publisher","first-page":"6397","DOI":"10.1097\/JS9.0000000000002761","volume":"111","author":"Y Liu","year":"2025","unstructured":"Liu Y, Yun H, Zhang W, Zou H, Chen N, Wang Y et al (2025) Robotic versus laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis of perioperative and oncologic outcomes. Int J Surg 111(9):6397\u20136411. https:\/\/doi.org\/10.1097\/JS9.0000000000002761","journal-title":"Int J Surg"},{"issue":"10","key":"3451_CR19","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1001\/jamaoncol.2020.3152","volume":"6","author":"F Liu","year":"2020","unstructured":"Liu F, Huang C, Xu Z, Su X, Zhao G, Ye J et al (2020) Morbidity and Mortality of Laparoscopic vs Open Total Gastrectomy for Clinical Stage I Gastric Cancer: The CLASS02 Multicenter Randomized Clinical Trial. JAMA Oncol 6(10):1590\u20131597. https:\/\/doi.org\/10.1001\/jamaoncol.2020.3152PubMed PMID: 32815991","journal-title":"JAMA Oncol"},{"issue":"5","key":"3451_CR20","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s10120-019-00929-9","volume":"22","author":"H Katai","year":"2019","unstructured":"Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N et al (2019) Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer 22(5):999\u20131008. https:\/\/doi.org\/10.1007\/s10120-019-00929-9PubMed PMID: 30788750","journal-title":"Gastric Cancer"},{"issue":"1","key":"3451_CR21","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1186\/s12885-020-07160-1","volume":"20","author":"C Yang","year":"2020","unstructured":"Yang C, Shi Y, Xie S, Chen J, Zhao Y, Qian F et al (2020) Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study. BMC Cancer 20(1):669. https:\/\/doi.org\/10.1186\/s12885-020-07160-1","journal-title":"BMC Cancer"},{"issue":"7","key":"3451_CR22","doi-asserted-by":"publisher","first-page":"5257","DOI":"10.1007\/s00464-021-08903-2","volume":"36","author":"M Hikage","year":"2022","unstructured":"Hikage M, Fujiya K, Kamiya S, Tanizawa Y, Bando E, Terashima M (2022) Comparisons of surgical outcomes between robotic and laparoscopic total gastrectomy in patients with clinical stage I\/IIA gastric cancer. Surg Endosc 36(7):5257\u20135266. https:\/\/doi.org\/10.1007\/s00464-021-08903-2PubMed PMID: 34997341","journal-title":"Surg Endosc"},{"issue":"4","key":"3451_CR23","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1007\/s10120-022-01288-8","volume":"25","author":"S Shibasaki","year":"2022","unstructured":"Shibasaki S, Nakauchi M, Serizawa A, Nakamura K, Akimoto S, Tanaka T et al (2022) Clinical advantage of standardized robotic total gastrectomy for gastric cancer: a single-center retrospective cohort study using propensity-score matching analysis. Gastric Cancer 25(4):804\u2013816. https:\/\/doi.org\/10.1007\/s10120-022-01288-8","journal-title":"Gastric Cancer"},{"issue":"1","key":"3451_CR24","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/s12893-025-02934-5","volume":"25","author":"J Chen","year":"2025","unstructured":"Chen J, Wang F, Wang Y, Zhou J, Yang Y, Zhao Z et al (2025) A comparison of postoperative outcomes between robotic-assisted and laparoscopic-assisted total gastrectomy: a comprehensive meta-analysis and systematic review. BMC Surg 25(1):212. https:\/\/doi.org\/10.1186\/s12893-025-02934-5","journal-title":"BMC Surg"},{"issue":"19","key":"3451_CR25","doi-asserted-by":"publisher","first-page":"3404","DOI":"10.3390\/cancers16193404","volume":"16","author":"M Manara","year":"2024","unstructured":"Manara M, Aiolfi A, Bonitta G, Schlanger D, Popa C, Lombardo F et al (2024) Short-Term Outcomes Analysis Comparing Open, Lap-Assisted, Totally Laparoscopic, and Robotic Total Gastrectomy for Gastric Cancer: A Network Meta-Analysis. Cancers (Basel) 16(19):3404. https:\/\/doi.org\/10.3390\/cancers16193404","journal-title":"Cancers (Basel)"},{"key":"3451_CR26","doi-asserted-by":"publisher","unstructured":"Murad F, Blasa F, Polette Stubb D, Lindblad M, Klevebro F, Kung CH et al (2025) Robotic-assisted versus conventional minimally invasive esophagectomy: a retrospective cohort study from a high-volume center. J Robot Surg 19(1). https:\/\/doi.org\/10.1007\/s11701-025-02590-0PubMed PMID: 40696050","DOI":"10.1007\/s11701-025-02590-0"},{"issue":"12","key":"3451_CR27","doi-asserted-by":"publisher","first-page":"8045","DOI":"10.1097\/JS9","volume":"110","author":"Z Li","year":"2024","unstructured":"Li Z, Zhou W, Yang W, Miao Y, Zhang Y, Duan L et al (2024) Efficacy and safety of robotic vs. laparoscopic gastrectomy for patients with gastric cancer: systematic review and meta-analysis. Int J Surg 110(12):8045\u20138056. https:\/\/doi.org\/10.1097\/JS90000000000001826 PubMed PMID: 38874467","journal-title":"Int J Surg"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03451-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03451-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03451-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T02:38:31Z","timestamp":1779244711000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03451-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3451"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03451-0","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"assertion":[{"value":"11 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"512"}}