Short-term outcomes of robotic versus laparoscopic gastrectomy for proximal gastric cancer: a systematic review and meta-analysis of propensity score-matched or baseline-balanced retrospective studies.

The optimal minimally invasive surgical approach for proximal gastric cancer (PGC) remains controversial. This systematic review and pairwise meta-analysis incorporated propensity score-matched (PSM) and retrospective studies with balanced baseline characteristics (BB) studies. The objective of this study was to evaluate perioperative outcomes of robotic gastrectomy (RG) compared with laparoscopic gastrectomy (LG) in patients with PGC. A comprehensive literature search was carried out in alignment with PRISMA standards to identify eligible studies. Short-term outcomes were categorized into four domains: surgical performance, resection quality, postoperative complications, and recovery outcomes. Mean differences (MDs) and odds ratios (ORs), along with their corresponding 95% confidence intervals (CIs), were calculated as effect size estimates. Assessment of study quality involved evaluating the risk of bias and assessing potential publication bias, while heterogeneity and its potential sources were examined through sensitivity and subgroup analyses. This study included five PSM studies and three BB studies, with a total of 1163 PGC patients. Although RG was associated with a longer operative time compared to LG, it demonstrated advantages including reduced intraoperative blood loss, a greater number of dissected lymph nodes, shorter hospital stay, and earlier onset of flatus and oral intake. No statistically significant differences were observed in proximal margin, distal margin, non-R0 resection rate, overall complications, major complications, anastomotic leakage, anastomotic stricture, or reflux esophagitis. RG may provide improved short-term outcomes over LG for PGC. However, further high-quality evidence is necessary to validate these findings and thoroughly assess long-term outcomes.PROSPERO Registration: CRD420251019756.