This single-institution retrospective cohort study evaluated perioperative outcomes of robot-assisted, video-assisted (laparoscopic or thoracoscopic) and open surgery across 13 oncologic procedure groups. The authors sought to avoid confounding introduced by aggregate, technology-level comparisons that mix different procedures and by differences in the calendar time when specialties adopted robotics. The explicit objective was a procedure-level comparison of perioperative safety and resource outcomes across a large contemporary surgical series.
Investigators identified 36,208 index oncologic procedures performed in 34,785 patients between January 2016 and December 2025 from the institutional clinical data warehouse. The analysis included 13 distinct cancer operations; the abstract does not enumerate every procedure or provide per-procedure sample sizes in full detail. The study is reported as a single-center experience from Seoul National University Hospital and affiliated programs.
The whole cohort analysis and 22 procedure-level pairwise comparisons were adjusted using stabilized inverse probability of treatment weighting (IPTW). Where tumor stage was not comparable across surgical approaches within a given indication, indication-specific cancer-site adjustment was applied. After weighting the whole cohort, all covariates reached a standardized mean difference of 0.10 or less, indicating balanced groups for the reported comparisons.
The primary outcome was major complications defined as Clavien–Dindo grade ≥ 3. Secondary outcomes included perioperative transfusion, length of hospital stay, 30-day readmission and conversion to open surgery. These outcomes were compared across robot-assisted, video-assisted (laparoscopic or thoracoscopic) and open approaches at the whole-cohort level and within procedure-specific pairwise analyses.
Over the study interval the institutional adoption of robot-assisted surgery increased markedly: the robot-assisted share rose from 16.8% in 2016 to 48.2% in 2025. Concurrently, the share of open surgery declined to 19.4% by 2025. The abstract frames these trends as context for interpreting perioperative comparisons and for understanding how technology adoption shifted procedure mix and practice patterns over time.
After whole-cohort weighting, the study reports procedure-level findings. For major complications, robot-assisted approaches had a significantly lower odds of major complications compared with open surgery for partial nephrectomy (odds ratio 0.33; 95% confidence interval 0.19 to 0.55) and radical prostatectomy (odds ratio 0.24; 95% confidence interval 0.13 to 0.42). The abstract does not supply the remaining procedure-specific odds ratios or confidence intervals in the text provided.
Robot-assisted approaches demonstrated lower perioperative transfusion rates in 14 of 22 procedure-level comparisons. Length of stay was shorter in 13 of those comparisons, with the largest reported reduction for robot-assisted radical cystectomy (geometric mean ratio 0.64 relative to the comparator). The abstract also lists 30-day readmission and conversion to open surgery as secondary outcomes, but detailed results for these endpoints and for every procedure-level comparison are not reported in the abstract.
The authors conclude that both robot-assisted and video-assisted approaches were associated with fewer major complications, fewer transfusions and shorter hospital stays than open surgery, with the most robust advantages observed for partial nephrectomy and radical prostatectomy. They argue that interpretation of comparative effectiveness should rely on procedure-level evidence rather than aggregated technology-level summaries when making decisions about robotic adoption and investment.
This abstract reports aggregated cohort size, analytic methods and selected comparative results but does not include full per-procedure sample sizes, the complete list of the 13 procedures, detailed numeric results for all 22 pairwise comparisons, long-term oncologic outcomes, or specific data on 30-day readmission and conversion rates for each procedure. Study design is retrospective and single-institutional, which may limit generalizability; the authors applied IPTW and indication-specific adjustments to mitigate observable confounding.
In this large single-institution series of 36,208 cancer operations from 2016–2025, adoption of robot-assisted surgery increased substantially and, after statistical adjustment, robot-assisted and video-assisted techniques were associated with lower major complications (notably for partial nephrectomy and radical prostatectomy), reduced transfusion rates and shorter lengths of stay compared with open surgery. The authors emphasize that procedure-level evidence should guide interpretation and decisions about robotic surgical investment.
Keywords: Comparative effectiveness research; Minimally invasive surgical procedures; Postoperative complications; Propensity score; Robotic surgical procedures; Surgical oncology.