Robotic surgical resection for Siewert II/III adenocarcinoma at the gastro-esophageal junction shows comparable overall survival to both laparoscopic and open techniques.

• Overall survival rates at 3 and 5 years are similar among robotic (OS OR 1.17; CI 0.10–14.06 and OS OR 0.66; CI 0.39–1.12), laparoscopic, and open approaches.
• A nonsignificant trend suggests improved disease-free survival with robotic techniques, but further investigation is needed.

Surgeons can consider robotic surgery as a viable option, knowing that it performs on par with established minimally invasive and open methods.

Recurrence after curative gastrectomy significantly reduces survival, especially in patients with high lymph node ratios (LNR).

• The probability of being alive and recurrence-free drops from 66.5% at 12 months to just 33.6% by 58 months.
• In high-LNR patients, 100% experience recurrence by 36 months, and only 11.3% are alive after recurrence at 12 months.
• Low-LNR patients fare better, with an extended survival period allowing for a lower mortality rate post-recurrence (62.5% vs. 80% over 24 months).

Surgeons should prioritize LNR in counseling and monitoring post-gastrectomy patients, as it crucially affects outcomes.