Evolution of Oncologic Results in D2 Gastrectomy for Cancer from 1970 to the Advent of Laparoscopic and Robotic Surgery: A Systematic Review and Meta- Analysis

Background D2 gastrectomy is the standard surgical treatment for resectable gastric cancer. Since the 1970s, surgical techniques have evolved from open to laparoscopic (1990s) and robotic (2000s) approaches. This systematic review and meta-analysis evaluates the evolution of oncologic outcomes across these eras. Methods We searched Cochrane, PubMed, and Embase (1970–2023) for studies reporting oncologic outcomes (overall survival [OS], disease-free survival [DFS], recurrence rates, lymph node yield) after D2 gastrectomy. Data were pooled using random-effects models. Subgroup analyses compared eras (1970–1990, 1991–2010, 2011–present) and surgical approaches (open, laparoscopic, robotic). Results 85 studies (52,340 patients) were included. Pooled 5-year OS improved from 40% (1970–1990) to 65% (2011–present). Lymph node yield increased from 15 to 30 nodes. Minimally invasive techniques (laparoscopic/robotic) achieved comparable OS/DFS to open surgery in the modern era, with robotic surgery showing higher lymph node yield (35 nodes) and lower recurrence (12%). Conclusion Oncologic outcomes after D2 gastrectomy have significantly improved over time, likely reflecting advances in surgical technique, perioperative care, and adjuvant therapy. Minimally invasive techniques, particularly robotic surgery, offer non-inferior outcomes to open surgery with potential advantages in lymph node dissection.