Comparison of minimally invasive gastrectomy outcomes between a university hospital and a general hospital: Evaluating the utility of robot-assisted gastrectomy

Background: The adoption of minimally invasive surgery has been rapidly increasing in Japan. However, few studies have compared the outcomes of university hospitals, which generate clinical trial data, with those of general hospitals, which reflect real-world clinical practice. This study evaluates the utility of robotic surgery by comparing the outcomes of minimally invasive gastrectomy performed at a university hospital (UH) and a general hospital (GH).
Methods: Patients who underwent laparoscopic gastrectomy (LG) or RG at UH or GH between January 2012 and December 2023 were analyzed. Propensity score matching (PSM) was performed to compare short-term outcomes between UH and GH
Results: In LG, 252 cases were analyzed for both UH and GH (UH: 521, GH: 255 before PSM). Median operative time (316 vs 349 min), blood loss (38.5 vs 52 g), and lymph node yield (42 vs 34) significantly differed, but there was no difference in Clavien-Dindo (CD) grade >2 complications (21.4 vs 23.0%). In RG, 100 cases per group (UH: 179, GH: 107 before PSM) were analyzed. Only lymph node yield (42 vs 37) showed a significant difference, while operative time, blood loss , and CD grade >2 complications (12 vs 8%) were comparable.
Conclusion: RG may reduce inter-institutional disparities in surgical quality and appears more feasible than LG.