Learning Curve in Robotic D2 Gastrectomy for Gastric Cancer: a Systematic Review and Meta-Analysis of Operative Proficiency and Postoperative Outcomes.

Background: Robotic-assisted D2 gastrectomy combines minimally invasive benefits with enhanced precision, though its technical complexity creates a significant learning curve. This study evaluates the learning process and its impact on surgical outcomes. Methods: We conducted a PRISMA-compliant meta-analysis of studies from major databases (2010-2023) including ≥10 robotic D2 gastrectomies. Outcomes assessed operative metrics, complications and oncological results using random-effects models. Results: Analysis of 30 studies (4,589 patients) revealed that proficiency required 25-50 cases. Significant improvements after achieving proficiency included 35% reduction in operative time (94.6 minutes), 50% less blood loss (89.2 mL), 18% increased lymph node yield (5.3 nodes) and 62% fewer major complications. High-volume centers achieved proficiency 12 cases sooner than low-volume counterparts. Conclusion: Robotic D2 gastrectomy demands 25-50 cases for mastery, with outcomes improving substantially post-learning curve. Centralized training and standardized protocols are crucial for optimal implementation.