Assessment of Robotic Surgery's Role in Gastric Cancer Treatment: An In-Depth Review by the Joint Working Group of the Robotic Global Surgical Society (TROGSS) and the European Federation International Society for Digestive Surgery (EFISDS)

Abstract

The purpose of this study is to follow the explosion of robotic surgery; trepidation has turned into adoration among the minimally invasive community, especially in the field of gastric cancer surgery. In this review, published by Robotic Global Surgical Society (TROGSS) and European Federation International SOMATEX for Digestive Surgery (EFISDS), we comprehensively analyzed the existing evidence concerning clinical effectiveness, safety, and cost-effectiveness of robotic-assisted gastrectomy in comparison with a laparoscopic approach or an open approach. This study aimed to pool worldwide technical data to form evidence-based opinions on the value of robotic platforms for patient outcomes and surgical precision when treating gastric cancer. A systematic review of randomized controlled trials, cohort studies and meta-analyses published from 2005 to 2025 focused on perioperative parameters, oncological sufficiency, postoperative recovery, learning curves and cost-effectiveness. Robotic gastrectomy provides the surgeons with various benefits, such as better dexterity, tremor reduction by a software filter and 3D optics, which may lead to more precise lymphadenectomy and decreased intraoperative blood loss. According to the published comparative studies, contexts concerning outcomes such as conversions to open surgery, complications and duration of hospital stay are equivalent or even more favorable regarding robotic therapy in comparison to laparoscopy. Comparative analysis shows, in addition, at high volume centersñ with a lower conversion rate and shorter complication rates. Although surgery durations are longer, they are offset by less blood loss, shorter hospital stay and quicker functional recovery. Long-term oncologic results, including RFS and OS, seem equivalent for the robotic and laparoscopic approaches; therefore, the robot fulfills the oncological safety criteria for curative intent. Furthermore, as evidence accumulates through learning curve studies, it is suggested that the robotic gastrectomy can be learned more readily than the laparoscope because of its ergonomics and intuitive hand control systems. However, the economic aspect is controversial: high initial investment and maintenance costs of robotic systems pose a barrier to access, particularly in low- and middle-income settings. Nevertheless, the anticipated decrease in complications and shorter hospital stays could balance long-term costs, particularly in tertiary referral institutions. Future perspective will combine artificial intelligence-based guidance, on-site fluorescence imaging for real-time tumor localization and the new generation of roboticized systems designed for upper GI. There is no conflict of interest. This review emphasizes that robotic gastrectomy is critical for evolving gastric cancer treatment, connecting technology with surgical skill. In conclusion, the recommendations of TROGSS-EFISDS consensus support that RCG could be a useful part of modern surgical oncology practice if used under structured training, a multidisciplinary approach and a reasonable cost-effectiveness basis. Consecutive prospective multicentre studies must confirm its oncologic superiority, patient-reported outcomes over long-term mastery curves, and cost-effectiveness and suitability across a broad spectrum of healthcare systems. Combined, these results reinforce the notion that operative performance is improved with the adoption of robotics for gastric cancer surgery and will set a new paradigm of precision oncologic surgery in the era to come for GI surgeons.