Comparison of partially extracorporeal versus totally intracorporeal Roux-en-Y reconstruction in robotic surgery for gastric cancer.

Background: Robotic surgery for gastric cancer has been increasingly performed globally. The ability to perform accurate dissection is recognized as a pivotal advantage. As for reconstruction, the debate remains as to whether it should be partially extracorporeal or totally intracorporeal with robotic manipulation.

Methods: This retrospective study reviewed the clinical data of patients who underwent robotic radical gastrectomy with Roux-en-Y reconstruction (total gastrectomy or distal gastrectomy) for gastric cancer between January 2023 and October 2024. Patients were divided into two groups depending on how jejunal limb was created: extracorporeal via mini-laparotomy (Extra group, n = 50) or totally intracorporeal (Intra group, n = 58). Esophagojejunostomy in total gastrectomy or gastrojejunostomy in distal gastrectomy was done intracorporeally in all patients. Surgical outcomes were compared between the two groups.

Results: The Intra group included more patients with high body mass index (BMI) (21.4 vs. 25.0 kg/m²; P < 0.001). In the entire cohort, the Intra group showed shorter reconstruction times (56.5 vs. 69 min). Multiple regression analysis showed distal gastrectomy (t = - 4.492, P < 0.001) and the totally intracorporeal reconstruction (t = - 2.607, P = 0.011) were significantly associated with shorter reconstruction time. Reconstruction time in the Intra group was little affected by patient's BMI. No anastomosis-related complications were recognized in either group.

Conclusions: Totally intracorporeal Roux-en-Y reconstruction in robotic gastric cancer surgery may reduce reconstruction time because there is no need to undock the robotic system and there are no surgical interruptions. Furthermore, it has the advantage of not being affected by patient's BMI.