Robotic Versus Open Surgical Approaches in Pancreatic and Gastric Cancers: A Review of Safety and How Well the Surgery is Done

Dr Adil Iqbal Daing * ¹, Dr Surender kumar Dabas ¹, Dr Sayyed Assif ¹

*Correspondence to: Dr Adil Iqbal Daing, MBBS MS FSO FSSO ACS RCSEdn ESO ASBrS ACRSI FMAS ELSA Consultant Advanced Surgical Oncology and Robotic Services Manipal Comprehensive Cancer Centre Dwarka New Delhi.

Copyright.

© 2026 Dr Adil Iqbal Daing, This is an open access article distributed under the Creative Commons Attribution   License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 7 March 2026

Published: 01 April 2026

DOI: https://doi.org/10.5281/zenodo.19352957

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.

Introduction

Pancreatic and gastric cancers represent a major global health burden, accounting for a significant proportion of cancer-related mortality worldwide. Despite advances in systemic therapies and early detection strategies, surgical resection remains the only potentially curative treatment for localized disease(1). However, surgery for these malignancies is technically demanding due to complex anatomy, proximity to major vascular structures, and the need for oncologically sound lymphadenectomy.

Open surgery has long been regarded as the gold standard for pancreatic and gastric cancer resections, offering direct exposure and tactile feedback. Nevertheless, open procedures are associated with considerable perioperative morbidity, prolonged hospitalization, and delayed recovery, which may adversely affect the timely initiation of adjuvant therapy(2).

The emergence of minimally invasive surgery marked a paradigm shift in gastrointestinal oncology. Robotic-assisted surgery, in particular, was developed to overcome the limitations of conventional laparoscopy by providing three-dimensional visualization, enhanced dexterity, tremor filtration, and improved ergonomics. These features have enabled surgeons to perform increasingly complex procedures, including pancreaticoduodenectomy and radical gastrectomy, with greater technical control (3).

Despite growing adoption, the role of robotic surgery in pancreatic and gastric cancer remains controversial. Questions persist regarding oncologic adequacy, complication profiles, operative efficiency, and long-term survival outcomes. Furthermore, issues such as learning curve, cost, and access continue to influence clinical decision-making. This review critically examines existing evidence comparing robotic and open approaches, focusing on oncologic outcomes, surgical precision, complications, and safety to assess how effectively surgery is performed using robotic systems(4).

Methodology

This review was conducted as a structured narrative synthesis of the current literature comparing robotic and open surgical approaches for pancreatic and gastric cancers(5). A comprehensive search was performed using PubMed, Scopus, and Google Scholar databases for articles published between January 2020 and December 2023.

The search strategy employed combinations of keywords including robotic surgery, open surgery, pancreatic cancer, gastric cancer, oncologic outcomes, lymph node retrieval, margin status, and postoperative complications. Reference lists of selected articles were manually screened to identify additional relevant studies.(6)

Inclusion criteria comprised systematic reviews, meta-analyses, randomized and non-randomized comparative studies, and large institutional series evaluating robotic versus open pancreatic or gastric resections. Studies focused solely on laparoscopic surgery without robotic comparison, case reports, and non-English publications were excluded(7).

Extracted data included study design, patient population, type of surgery, operative parameters, lymph node yield, resection margin status, postoperative morbidity, hospital stay, and survival outcomes. Due to heterogeneity across studies, findings were synthesized qualitatively rather than pooled quantitatively.

Oncologic Outcomes

Oncologic efficacy is the cornerstone of surgical cancer treatment. Adequate lymph node dissection and achievement of negative resection margins are critical determinants of long-term survival in both pancreatic and gastric cancers. Across multiple comparative studies, robotic surgery demonstrated oncologic outcomes comparable to those of open surgery.

Robotic gastrectomy has consistently shown equivalent or higher lymph node yields, particularly in technically challenging nodal stations such as suprapancreatic and paraesophageal regions. Similarly, robotic pancreatic resections achieved acceptable lymph node counts aligned with international oncologic standards(8).

Margin-negative (R0) resection rates were comparable between robotic and open approaches in both malignancies. Enhanced visualization and refined dissection capabilities of robotic platforms may facilitate precise tumor clearance, especially in anatomically restricted spaces. Short-term survival outcomes, including disease-free survival, were similar between groups, while long-term survival data remain limited and warrant further investigation(9).

Surgical Precision and Technical Aspects

Robotic surgery provides several technical advantages that directly influence surgical quality. Articulated instruments with multiple degrees of freedom allow precise dissection around critical vascular and neural structures. Three-dimensional magnified imaging enhances depth perception, enabling meticulous tissue handling and accurate identification of anatomical planes(10).

These advantages are particularly relevant in pancreatic surgery, where safe dissection near the superior mesenteric vessels is essential, and in gastric surgery, where extended lymphadenectomy is required. Robotic platforms also improve surgeon ergonomics, potentially reducing fatigue during prolonged procedures.

However, robotic surgery is associated with longer operative times, especially during early adoption. Studies indicate that operative duration decreases significantly with increasing experience, highlighting the importance of structured training and institutional volume(11).

Complications and Safety

Postoperative complications significantly affect patient recovery and healthcare utilization. Evidence indicates that robotic surgery is associated with reduced intraoperative blood loss and lower wound-related complications compared with open surgery. Minimally invasive access also contributes to decreased postoperative pain and faster functional recovery(12).

Major complications such as pancreatic fistula, anastomotic leak, and postoperative infections occurred at similar rates between robotic and open approaches. Importantly, robotic surgery did not demonstrate increased mortality when performed in experienced centers(13).

Shorter hospital stays observed with robotic approaches may facilitate earlier initiation of adjuvant therapy, which is particularly important in pancreatic cancer management.

Discussion

This review demonstrates that robotic surgery offers a safe and oncologically effective alternative to open surgery for pancreatic and gastric cancers. The benefits of enhanced precision, reduced morbidity, and faster recovery must be balanced against longer operative times, higher costs, and the need for specialized training(18-19).

The success of robotic surgery is highly dependent on surgeon experience and institutional case volume. High-volume centers with structured training programs consistently report superior outcomes. Cost-effectiveness remains a challenge; however, reduced complications and shorter hospital stays may offset initial expenses in the long term(20,22).

Future research should prioritize randomized controlled trials, standardized outcome measures, and long-term survival analysis to better define the role of robotic surgery in upper gastrointestinal oncology (23,25).

Conclusion

Robotic surgery represents a significant advancement in the surgical management of pancreatic and gastric cancers. Current evidence supports its safety, technical feasibility, and oncologic adequacy when compared with open surgery. While robotic platforms offer clear perioperative advantages, their effectiveness depends on surgeon expertise, institutional infrastructure, and appropriate patient selection. Continued research and long-term outcome data are essential to establish standardized guidelines and ensure optimal integration of robotic surgery into oncologic practice.

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