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目的:分析与比较机器人辅助胃癌切除术（RAG）与传统腹腔镜辅助胃癌切除术（LAG）后患者的复发结局。方法:采用回顾性队列研究方法。纳入2015年1月1日至2019年6月30日期间，国内四家大型胃癌诊治中心接受微创胃癌根治术、并经术后组织学证实为T1~4aN0~3M0期的2 915例胃腺癌患者的临床资料。其中福建医科大学附属协和医院1 426例，南昌大学第一附属医院1 108例，天津医科大学肿瘤医院196例，西安交通大学第一附属医院185例。其中930例接受RAG（机器人手术组），1 985例接受LAG（腹腔镜手术组）。基于年龄、性别、体质指数、美国麻醉医师协会（ASA）评分、合并症、肿瘤大小、手术范围、淋巴结清扫范围、pT、pN、手术年份和辅助化疗等特征，使用1∶1倾向性评分匹配法，将机器人手术组与腹腔镜手术组患者进行配比。配比后每组各纳入837例进行最终分析。两组的临床基线资料差异无统计学意义（均 P>0.05）。对两组的3年无复发生存率（RFS）、复发模式和条件复发生存（cRFS）结局进行比较。 结果:术后3年随访中，机器人手术组和腹腔镜手术组分别有128例（15.3%）和141例（16.8%）患者出现复发（ P=0.387），首次复发时间分别为（15.7±8.1）个月和（16.4±8.4）个月（ P=0.449），差异均无统计学意义；两组患者中腹膜复发占比最高，分别为55例（6.6%）和69例（8.2%），两组比较差异无统计学意义（ P=0.524）。机器人手术组与腹腔镜手术组的3年RFS差异没有统计学意义（83.2%比82.5%， P=0.781）。年龄>60岁、全胃切除术，pT分期较晚和pN分期较晚是胃癌患者复发的独立危险因素（均 P<0.05）；而采用机器人手术还是腹腔镜手术，并不是影响胃癌患者RFS的独立风险因素（ P=0.242）。机器人手术组与腹腔镜手术组患者在术后各生存时间截点的3年cRFS具有可比性（术后1年：84.6%比84.7%， P=0.793；术后3年：91.5%比94.9%， P=0.647）。 结论:由大型胃癌诊治中心外科医师施行RAG治疗局部可切除胃癌患者的3年复发率和复发模式均不劣于LAG。

Objective:To compare and evaluate recurrence patterns after robotic-assisted gastrectomy (RAG) versus laparoscopic-assisted gastrectomy (LAG).Methods:This was a retrospective cohort study of 2915 consecutive patients with gastric adenocarcinoma confirmed by postoperative histology as T1-4aN0-3M0, who had undergone minimally invasive radical gastrectomy at four large gastric cancer treatment centers (Fujian Medical University Union Hospital: 1426 patients; the First Affiliated Hospital, Nanchang University: 1108; Tianjin Medical University Cancer Institute and Hospital: 196; and First Affiliated Hospital of Xi'an Jiaotong University: 185 cases) between 1 January 2015 and 30 June 2019. 930 patients had undergone RAG (RAG group) and 1985 had undergone LAG (LAG group). We assessed the following characteristics: age, sex, body mass index, American Society of Anesthesiologists score, comorbidities, tumor size, extent of surgery, extent of lymph node dissection, pT, pN, year of surgery, and adjuvant chemotherapy, after propensity score matching (1:1). There were no significant differences in baseline clinical characteristics between the two groups formed by propensity score matching (837 in each group) (all P>0.05). The 3-year recurrence-free survival (RFS), recurrence pattern, and conditional RFS were compared. Results:We detected no significant differences in the overall recurrence rate at 3 years (128/837 [15.3%] vs. 141/837 [16.8%], P=0.387) or time to recurrence (15.7±8.1 months vs. 16.4±8.4 months, P=0.449) between the RAG and LAG groups. Peritoneal recurrence was the most common type of recurrence in both groups (55 [6.6%] vs. 69 [8.2%], P=0.524). The difference in 3-year RFS between the RAG and LAG groups was not statistically significant (83.2% vs. 82.5%, P=0.781). We found that age > 60 years, total gastrectomy, and worse pT stage and pN stage were independent risk factors for recurrence in the study patients (all P<0.05), whereas the surgical procedure (RAG or LAG) was not an independent risk factor for RFS ( P=0.242). The 3-year conditional RFS at various time points was comparable between the two groups (1 year postoperatively: 84.6% vs. 84.7%, P=0.793; 3 years postoperatively: 91.5% vs. 94.9%, P=0.647). Conclusions:In this multicenter study of patients with locally resectable gastric cancer, we demonstrated that RAG performed by surgeons at large gastric cancer centers is not inferior to LAG in 3-year recurrence rate or recurrence patterns.