Possibly more favorable short-term outcomes with minimally invasive surgery than with open surgery in total gastrectomy for locally advanced gastric cancer: A single high-volume center study

Background

Minimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short-term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated.

Methods

We retrospectively compared short-term outcomes between MTG and OTG for locally advanced gastric and esophago-gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders.

Results

In total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien–Dindo classification (C-D) ≥3 than the OTG group (3.2% vs. 11.6%, p = 0.026). Moreover, the rate of postoperative intra-abdominal infectious complications (IAIC) was significantly lower in the MTG than in the OTG group (C-D ≥ 2; 7.4% vs. 17.9%, p = 0.029 and C-D ≥ 3; 2.1% vs. 9.5%, p = 0.030, respectively). Subgroup analyses showed the odds ratios for IAIC with C-D ≥ 2 to be more favorable for the MTG than the OTG group in male patients, those ≥70 years of age, patients without esophageal invasion, those without neoadjuvant chemotherapy, those diagnosed with cT≥3, and patients not undergoing combined resection of other organs except for the gallbladder or spleen.

Conclusions

MTG for locally advanced gastric cancer may provide improved short-term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.