Abstract
BACKGROUND: The impact of robotic gastrectomy (RG) surgery on advanced gastric cancer following neoadjuvant therapy remains a topic of debate. A thorough search and analysis of the current relevant evidence is needed. This study aims to evaluate the efficacy, safety, and advantages of RG for gastric cancer after neoadjuvant therapy, comparing it with traditional laparoscopic gastrectomy (LG) surgery. METHODS: We searched databases,including PubMed, Embase, Web of Science,Cochrane Library, and Chinese National Knowledge Infrastructure(CNKI),to identify studies up to May 10, 2025. Four non-randomized controlled trials from East Asia involving neoadjuvant therapy for advanced gastric cancer with RG and LG interventions were included. The outcomes assessed include: postoperative complications, operative time, blood loss, postoperative hospital stays, number of lymph node dissections, the first flatus, the first time on liquid diets, re-admission within 30 days after surgery, reoperation within 30 days after surgery, open conversion, prevalence of serious complications. RESULTS: A total of four studies enclosed by 569 participants were incorporated into the analysis. The findings reveal that RG significantly extended operative time [mean difference(MD): 82.16,95%CI: 65.39 to 98.94, P < 0.00001, I(2) = 30%] when compared to LG.; However, it significantly reduced the time to the patient's first flatus (MD: -0.60,95%CI:-0.70 to-0.51, P < 0.00001, I(2) = 0%)and the first time on liquid diets[MD:1.33,95%confidence interval(CI):-1.51to-1.16, P < 0.00001, I(2) = 0%], while also increasing the number of lymph nodes(MD: 1.76;95%CI:0.26to3.26, P = 0.02, I(2) = 0%). Furthermore, the findings of this study demonstrate that there were no statistically significant differences between the RG and LG,with postoperative complications [odds ratio, OR: 0.81;95%CI: 0.35-1.87, P = 0.62, I(2) = 65%], blood loss(MD: 2.34;95%CI: -6.43to11.10, P = 0.60, I(2) = 0%), open conversion(OR: 0.66;95%CI: 0.18-2.38, P = 0.52, I(2) = 0%), postoperative hospital stays(MD: -0.29;95%CI:-0.72to0.15, P = 0.19, I(2) = 29%), reoperation within 30 days after surgery(OR: 0.49;95% CI:0.09,2.73, P = 0.42, I(2) = 0%), re-admission within 30 days after surgery(OR: 0.59; 95% CI: 0.18,1.93, P = 0.38, I(2) = 0%), and prevalence of serious complications(OR = 0.61, 95% CI: (0.29, 1.24), P = 0.17, I(2) = 0%). CONCLUSION: Based on available data suggests that robotic surgery after neoadjuvant therapy is a treatment approach with great potential for development and may be used as a new treatment method for locally advanced gastric cancer. TRIAL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025643235 , PROSPERO (42,025,643,235).