Clinical and economic outcomes of robotic vs open gastrectomy: A propensity score-matched analysis during the implementation phase of a robotic gastrectomy program at a cancer center.

335 Background: Robotic gastrectomy (RG) has gained rapid global adoption, yet the high cost of robotic platforms continues to limit widespread, value-based utilization. Evidence on perioperative costs during the early implementation phase of RG programs remains scarce. We sought to compare perioperative costs and short-term outcomes between RG and open gastrectomy (OG) at our center during program initiation. Methods: We retrospectively reviewed patients who underwent curative-intent total, proximal, or distal gastrectomy (TG, PG, or DG) for gastric adenocarcinoma between 2018 and 2025. The primary outcome was total perioperative cost; secondary outcomes included postoperative opioid use and other short-term outcomes. To preserve confidentiality, costs were expressed as ratios relative to the average cost of all operations performed at our institution in FY2021. Covariates including sex, age, race, body mass index (BMI), diabetes mellitus, neoadjuvant chemotherapy, resection type (TG or PG vs. DG), and clinical stage (cT, cN) were balanced using propensity score (PS) matching and inverse probability of treatment weighting (IPTW). Continuous variables were compared using Welch’s t-test. Results: Of 293 eligible patients, 85 in each group were analyzed after PS matching. Intraoperative expenses were significantly higher for RG compared with OG (2. 67 ± 0. 49 vs. 1. 77 ± 0. 36; p < 0. 001). However, total perioperative costs—including operative, inpatient, outpatient, and readmission expenses—were comparable between groups (RG: 6. 70 ± 4. 55 vs. OG: 6. 81 ± 3. 67; p = 0. 861). Length of stay was shorter for RG (4. 72 ± 4. 58 vs. 7. 26 ± 4. 84 days; p < 0. 001), and readmission rates were lower with RG (9. 4% vs. 21. 2%; p = 0. 055). Opioid requirements during postoperative days 0–4 were also reduced in RG (71. 46 ± 135. 68 vs 115. 76 ± 116. 86 morphine equivalents; p = 0. 024). These findings offset higher operative costs and remained consistent after PS-IPTW adjustment. Conclusions: Although intraoperative expenses were greater, RG demonstrated comparable total perioperative costs relative to OG, while conferring important clinical benefits, including shorter hospitalization, fewer readmissions, reduced opioid requirements, and lower intraoperative blood loss. These findings suggest that, even during the early implementation phase, RG offers both clinical and economic value when performed at experienced centers. Clinical trial information: PA1820100854.