Outcomes of Reduced-Port Robotic Gastrectomy Compared With the Conventional Laparoscopy in Korea (KLASS-13).

Abstract

Purpose: Radical gastrectomy with lymphadenectomy remains the standard treatment for gastric cancer. Minimally invasive gastrectomy, particularly the reduced-port robotic gastrectomy (REPROG), has gained attention because of its precision and reduced invasiveness. This study aimed to establish a nationwide REPROG database in Korea and to evaluate its clinical outcomes.

Materials and methods: All patients who underwent REPROG between February 2014 and December 2023 were analyzed. A comprehensive analysis of these patients, including perioperative outcomes, was conducted. To compare outcomes, a control group was selected from the 2019 Korea Nationwide Gastrectomy Database, focusing on patients receiving multiport conventional laparoscopic gastrectomy (CLG). A 1:2 propensity score matching was performed based on patient, tumor, and surgical characteristics. Perioperative outcomes, including the length of hospital stay, were compared between the matched cohorts.

Results: A total of 1,071 patients who underwent REPROG were collected, of which 1,060 were included after exclusion and compared with CLG cases from a nationwide database. REPROG demonstrated a significant reduction in hospital stay, with a mean duration of 6.1 days compared with 7.8 days for the CLG (P<0.001). The incidence of major complications was similar between the 2 groups (1.9% vs. 2.4%, P=0.493). The conversion rate for REPROG was 0.19%. The annual number of patients receiving REPROG steadily increased, reaching 267 patients (24.9%) by 2023.

Conclusions: Patients undergoing REPROG had a shorter hospital stay and a low conversion rate, indicating its potential as a treatment option for gastric cancer when performed by highly experienced surgeons.