{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:09:46Z","timestamp":1781532586559,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"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\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the safety and short-term efficacy of radical gastrectomy using the Da Vinci fully robotic system versus laparoscopic surgery under a standardised enhanced recovery after surgery (ERAS) protocol, with multivariate adjustment for baseline differences in tumour stage and nutritional status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective case-control analysis of 259 patients (RTG: n=121; LTG: n=138) undergoing gastric cancer radical surgery at Jiangsu Provincial Hospital of Traditional Chinese Medicine (August 2018\u2013July 2022) under a uniform institutional ERAS protocol. Univariate comparisons were supplemented by multivariate regression analyses adjusting for pathological TNM stage, preoperative albumin, age, and BMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The RTG group had significantly earlier pathological TNM staging (Stage I: 40.5% vs. 21.7%, p=0.003) and higher preoperative albumin (40.8 vs. 39.05 g\/L, p&amp;lt;0.001). In univariate analysis, the RTG group demonstrated shorter median postoperative hospital stay (6 vs. 9 days, p&amp;lt;0.001), a markedly lower rate of prolonged hospitalisation &amp;gt;14 days (1.7% vs. 14.5%, OR\u00a0=\u00a010.1, p=0.001), earlier first oral intake (6 vs. 42.75\u00a0h, p&amp;lt;0.001), earlier first ambulation (20 vs. 38\u00a0h, p&amp;lt;0.001), fewer ICU admissions (5.0% vs. 17.4%, p=0.002), a higher rate of adequate lymph node dissection (\u226510 groups: 72.7% vs. 44.2%, p&amp;lt;0.001), a lower rate of clinically significant blood loss (&amp;gt;100\u00a0ml: 2.5% vs. 19.6%, p&amp;lt;0.001), and significantly better preservation of postoperative albumin on day 1 (\u0394 \u22122.0 vs. \u0394 \u22123.9 g\/L, p=0.001) and day 5 (\u0394 \u22120.7 vs. \u0394 \u22123.2 g\/L, p&amp;lt;0.001). The largest recovery gap was observed in total gastrectomy (7 vs. 11 days, p=0.002) despite equal operative time (285 vs. 288\u00a0min, p=0.969). In multivariate regression adjusting for all covariates, the robotic approach remained independently associated with all primary recovery outcomes (hospital stay \u03b2=\u22123.25 days, first liquid intake \u03b2=\u221241.71 h, first ambulation \u03b2=\u221216.45 h, drain duration \u03b2=\u22121.79 days; all p&amp;lt;0.001). The overall complication rate did not differ significantly (5.0% vs. 7.2%, OR\u00a0=\u00a00.68, 95% CI 0.24\u20131.94, p=0.606);\n                      <jats:italic>post-hoc<\/jats:italic>\n                      power was 11.6%, indicating the comparison was statistically inconclusive.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Robotic radical gastrectomy within a uniform ERAS protocol is independently associated with superior short-term postoperative recovery \u2014 including shorter hospitalisation, earlier oral intake, better nutritional preservation, and higher-quality lymph node dissection \u2014 compared to laparoscopic surgery, an advantage that persists after multivariate adjustment for tumour stage and is consistent across all subgroups examined. Multi-centre prospective trials are required to confirm long-term oncological outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1793088","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:46:39Z","timestamp":1779252399000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A retrospective case-control study of Da Vinci robotic versus laparoscopic radical gastrectomy for gastric cancer under an enhanced recovery after surgery protocol"],"prefix":"10.3389","volume":"16","author":[{"given":"Wen-hao","family":"Sun","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao-di","family":"Wang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Wang","sequence":"additional","affiliation":[{"name":"Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-yue","family":"Shao","sequence":"additional","affiliation":[{"name":"Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng-ming","family":"Deng","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-wei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in China, 2022","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101404","article-title":"The current and future incidence and mortality of gastric cancer in 185 countries, 2020\u201340: a population-based modelling study","volume":"47","author":"Morgan","year":"2022","journal-title":"EClinicalMedicine"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-022-01331-8","article-title":"Japanese gastric cancer treatment guidelines 2021 (6th edition)","volume":"26","year":"2023","journal-title":"Gastric Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.07.004","article-title":"Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"33","author":"Lordick","year":"2022","journal-title":"Ann Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9582","article-title":"Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS\u00ae) Society recommendations","volume":"101","author":"Mortensen","year":"2014","journal-title":"Br J Surg"},{"key":"B7","article-title":"Laparoscopy-assisted Billroth I gastrectomy","volume":"4","author":"Kitano","year":"1994","journal-title":"Surg Laparosc Endosc"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31288-5","article-title":"Gastric cancer. Lancet","volume":"396","author":"Smyth","year":"2020"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.5104","article-title":"Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: five-year outcomes from the CLASS-01 randomized clinical trial","volume":"157","author":"Huang","year":"2022","journal-title":"JAMA Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.0096","article-title":"Five-year survival outcomes of laparoscopy-assisted vs open distal gastrectomy for advanced gastric cancer: the JLSSG0901 randomized clinical trial","volume":"158","author":"Etoh","year":"2023","journal-title":"JAMA Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3543-9","article-title":"30 years of robotic surgery","volume":"40","author":"Leal Ghezzi","year":"2016","journal-title":"World J Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24146","article-title":"Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: a randomized clinical trial","volume":"113","author":"Wang","year":"2016","journal-title":"J Surg Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-023-01389-y","article-title":"Robotic gastrectomy for gastric cancer: systematic review and future directions","volume":"26","author":"Shibasaki","year":"2023","journal-title":"Gastric Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.3182","article-title":"Short-term outcomes of robotic gastrectomy vs laparoscopic gastrectomy for patients with gastric cancer: a randomized clinical trial","volume":"156","author":"Ojima","year":"2021","journal-title":"JAMA Surg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004466","article-title":"Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial","volume":"273","author":"Lu","year":"2021","journal-title":"Ann Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-49013-6","article-title":"Robotic versus laparoscopic distal gastrectomy for resectable gastric cancer: a randomized phase 2 trial","volume":"15","author":"Lu","year":"2024","journal-title":"Nat Commun"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-022-05448-0","article-title":"Short-term surgical outcomes of robotic gastrectomy compared to open gastrectomy for patients with gastric cancer: a randomized trial","volume":"26","author":"Ribeiro","year":"2022","journal-title":"J Gastrointest Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.07.053","article-title":"Robotic versus laparoscopic gastrectomy for gastric cancer: the largest meta-analysis","volume":"82","author":"Guerrini","year":"2020","journal-title":"Int J Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-023-13654-6","article-title":"Minimally invasive and open gastrectomy for gastric cancer: a systematic review and network meta-analysis of randomized clinical trials","volume":"30","author":"Davey","year":"2023","journal-title":"Ann Surg Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005046","article-title":"Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a multicenter cohort study of 5402 patients in China","volume":"277","author":"Li","year":"2023","journal-title":"Ann Surg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.01540","article-title":"Laparoscopic versus open gastrectomy for gastric cancer (LOGICA): a multicenter randomized clinical trial","volume":"39","author":"van der Veen","year":"2021","journal-title":"J Clin Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-019-00979-z","article-title":"Robotic-assisted gastrectomy for gastric cancer: a European perspective","volume":"22","author":"van Boxel","year":"2019","journal-title":"Gastric Cancer"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-022-02674-3","article-title":"Laparoscopic versus open surgery for locally advanced and metastatic gastric cancer complicated with bleeding and\/or stenosis: short- and long-term outcomes","volume":"20","author":"Khorobrykh","year":"2022","journal-title":"World J Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005727","article-title":"Intraoperative adverse events, technical performance, and surgical outcomes in laparoscopic radical surgery for gastric cancer: a pooled analysis from 2 randomized trials","volume":"278","author":"Liu","year":"2023","journal-title":"Ann Surg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.924444","article-title":"Does intraoperative blood loss affect the short-term outcomes and prognosis of gastric cancer patients after gastrectomy? A meta-analysis","volume":"9","author":"Wen","year":"2022","journal-title":"Front Surg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i22.2743","article-title":"Long-lasting discussion: adverse effects of intraoperative blood loss and allogeneic transfusion on prognosis of patients with gastric cancer","volume":"25","author":"Nakanishi","year":"2019","journal-title":"World J Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-021-08903-2","article-title":"Comparisons of surgical outcomes between robotic and laparoscopic total gastrectomy in patients with clinical stage I\/IIA gastric cancer","volume":"36","author":"Hikage","year":"2022","journal-title":"Surg Endosc"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-018-00906-8","article-title":"Clinical advantages of robotic gastrectomy for clinical stage I\/II gastric cancer: a multi-institutional prospective single-arm study","volume":"22","author":"Uyama","year":"2019","journal-title":"Gastric Cancer"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1186\/s13741-022-00238-3","article-title":"Postoperative decrease of albumin (\u0394Alb) as early predictor of complications after gastrointestinal surgery: a systematic review","volume":"11","author":"Joliat","year":"2022","journal-title":"Perioper Med (Lond)"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.583422","article-title":"Postoperative ileus and postoperative gastrointestinal tract dysfunction: pathogenic mechanisms and novel treatment strategies beyond colorectal enhanced recovery after surgery protocols","volume":"11","author":"Mazzotta","year":"2020","journal-title":"Front Pharmacol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1793088\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:22:03Z","timestamp":1781529723000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1793088\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":30,"alternative-id":["10.3389\/fonc.2026.1793088"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1793088","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"article-number":"1793088"}}