Abstract

Background: Minimally invasive surgery has transformed gastrointestinal oncology, with robotic platforms increasingly adopted for complex procedures such as pancreatic and gastric cancer resections. While robotic surgery offers enhanced visualization, precision, and ergonomic advantages, concerns remain regarding oncologic adequacy, safety, and overall surgical quality compared with conventional open surgery. A clear synthesis of current evidence is essential to guide surgical decision-making.

Objective: This review aims to critically compare robotic and open surgical approaches in pancreatic and gastric cancers, focusing on surgical safety, technical precision, oncologic outcomes, and postoperative complications, to evaluate how effectively surgery is performed using robotic systems.

Methods: A structured narrative review was conducted using peer-reviewed studies, meta-analyses, and systematic reviews published between 2020 and 2023. The analysis focused on operative outcomes, lymph node retrieval, margin status, postoperative morbidity, and survival metrics in robotic versus open pancreatic and gastric cancer surgeries. Key evidence was synthesized from high-impact surgical oncology literature.

Results: Robotic surgery demonstrated comparable oncologic safety to open surgery, with equivalent or improved lymph node harvest and negative resection margin rates in both pancreatic and gastric cancer procedures. Enhanced dexterity and three-dimensional visualization contributed to improved surgical precision, particularly in confined anatomical spaces. Postoperative outcomes favored robotic approaches, showing reduced blood loss, lower complication rates, and shorter hospital stays, although operative time was generally longer. No significant differences were observed in short-term survival outcomes between the two approaches.

Conclusion: Current evidence supports robotic surgery as a safe and oncologically sound alternative to open surgery for selected patients with pancreatic and gastric cancers. While robotic platforms offer technical and perioperative advantages, outcomes remain highly dependent on surgeon expertise and institutional experience. Further long-term, randomized studies are needed to confirm survival benefits and establish standardized guidelines for broader implementation.

Keywords: Robotic surgery, Open surgery, Pancreatic cancer, Gastric cancer, Surgical oncology, Oncologic outcomes.