Purpose <p>This research conducts a comparison of Totally Robotic Total Gastrectomy (TRTG) and Robot-Assisted Total Gastrectomy (RATG) to evaluate their relative outcomes in patients with advanced gastric cancer, providing evidence to guide individualized surgical strategy selection.</p> Methods <p>We retrospectively gathered clinical data from patients who underwent either TRTG or RATG between January 2015 and December 2021, totaling 204 participants. After applying Propensity Score Matching (PSM), the matched cohort consisted of 118 patients, with 59 individuals in each of the TRTG and RATG groups. The study then compared the short-term and long-term outcomes between these two groups.</p> Results <p>Post-matching, there were no significant baseline differences between the groups. Surgery duration and anastomosis duration were both longer in the TRTG group than in the RATG group. However, TRTG was associated with significantly reduced intraoperative blood loss, shorter times to postoperative mobilization, flatus, and eating, decreased hospital stay, smaller incision sizes, and lower postoperative stress responses compared to RATG. The RATG group harvested a higher number of lymph nodes. No significant differences were observed between the two groups regarding postoperative complications, proximal and distal margins, nerve invasion, vascular cancer thrombus, postoperative drainage output, and hospitalization costs. The three-year overall survival and disease-free survival rates were similar between both groups.</p> Conclusions <p>TRTG offers a safer and more advantageous surgical option regarding short-term outcomes compared to RATG and may be considered a preferable choice for total gastrectomy.</p>