Objective: Minimally invasive surgery has become popular in the treatment of gastric cancer Background: Few reports have compared operative outcomes among laparoscopic, 3D-laparoscopic and robotic gastrectomy for distal gastric cancer. Methods: Between August 2011 and June 2020, a total of 245 patients underwent either laparoscopic (n=129), 3D-laparoscopic (n=55) or robotic (n=61) gastrectomy for distal gastric cancer; the clinicopathologic characteristics and operative outcomes were compared between groups. Results: Compared with the laparoscopic group, the 3D-laparoscopic and robotic groups were associated with more D2 lymphadenectomy, higher medical costs and a longer operative time, while the number of retrieved lymph nodes and surgical complications were similar among the three groups. For patients receiving D2 lymphadenectomy, the robotic group was associated with higher medical costs and longer operative time than the other two groups; high-body mass index (high-BMI) patients had a longer operative time than low-BMI patients in the laparoscopic group, which was not significantly different between low- and high-BMI patients in both the 3D-laparoscopic and robotic groups. For low-BMI patients, the medical costs were higher and the operative time was longer in the robotic group than the other two groups. For high-BMI patients, the robotic group was associated with higher medical costs, longer operative time and postoperative hospital stay than the other two groups. Conclusions: 3D-laparoscopic gastrectomy was associated with affordable medical costs, comparable lymphadenectomy, and similar surgical outcomes compared with robotic gastrectomy.

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