Robotic-assisted gastrectomy for 700 gastric cancer patients: A comparative analysis between specialized centers in Italy and Korea

INTRODUCTION: Robotic surgery is a safe approach for gastric cancer. Most available evidence originates from East Asia, while data from European centers remain limited. This study aims to compare surgical and oncological outcomes between different countries, focusing on the number of lymph node retrieved. MATERIALS AND METHODS: We included adult patients who underwent curative-intent distal or total robotic gastrectomy for gastric cancer between 2017 and 2024 at specialized centers in Tuscany (Italy) and the Seoul National University Hospital (South Korea). RESULTS: A total of 700 patients were enrolled, including 232 Italian and 468 Korean patients. Western patients were older, had a higher comorbidity burden, and had more advanced disease (64.7% vs. 28.6%). Neoadjuvant chemotherapy and D2 lymphadenectomy were more frequently performed in Western centers, whereas D1+ was preferred in Eastern centers (p < 0.001). Median node retrieved was 34 (West 38 vs. East 33 nodes), exceeding oncological thresholds (>15) across all pathological stages. Lymph node retrieved increased with pT stage and was independent of age, while higher BMI was associated with lower nodal retrieval (31 vs. 35 nodes). Postoperative surgical complications were higher in the Western cohort (13.4% vs. 8.1%, p = 0.029), with an increased rate of anastomotic leakage (p < 0.001). Length of stay and perioperative mortality were comparable between centers. CONCLUSION: Robotic gastrectomy ensures adequate lymphadenectomy and acceptable perioperative outcomes in both Italian and Korean centers. Observed differences in operative efficiency, morbidity, and survival mainly reflect variations in patient selection and disease stage rather than surgical quality, supporting centralization and earlier diagnosis at Western populations.