The Role of Robotic Gastrectomy in the Elderly Population: A Systematic Review With Meta-analysis

Background: As the gastric cancer patient population ages, identifying safe surgical treatments for frail elderly patients is critical. This meta-analysis evaluates the surgical safety, recovery, and oncological efficacy of robotic gastrectomy (RG) in the elderly, comparing it to laparoscopic gastrectomy (LG) in the same demographic and RG in younger patients. Material and Methods: A systematic search (PubMed, Embase, Web of Science, Scopus) identified relevant studies. Perioperative outcomes, complications, and oncological efficacy were analyzed, calculating pooled prevalences, odds ratios (ORs), and mean differences (MDs) using R. Results: In the elderly, RG demonstrated advantages over LG, including shorter hospital stays (MD = −0.83 d), faster liquid diet transition (MD = −0.19 d, exploratory), and higher lymph node retrieval (MD = 2.68). RG had significantly fewer overall (OR = 0.72) and grade I-II complications (OR = 0.66, exploratory), and lower medical morbidities (OR = 0.53, exploratory), but required a longer operative time (MD = 19.5 min). Blood loss, mortality, and severe complications were comparable. Compared with younger RG patients, the elderly had longer hospital stays (MD = 1.18 d) and more severe (grade III-IV) complications (OR = 2.20), with no significant differences in operative time, overall complications, or mortality. Conclusion: RG offers significant benefits for elderly gastric cancer patients, improving recovery and reducing mild complications compared with LG, without compromising oncological outcomes. Because the elderly remain inherently vulnerable to severe complications compared with younger cohorts, comprehensive preoperative functional assessment, rather than chronological age alone, is essential for optimal patient selection.