Comparison of laparoscopic and open total gastrectomy with D2 lymphadenectomy for gastric cancer: a propensity score matched study.

BACKGROUND

Laparoscopic total gastrectomy (LTG) is increasingly performed for gastric cancer, yet concerns remain regarding its oncologic adequacy compared to open total gastrectomy (OTG), especially outside of randomized clinical trials. Real-world data comparing both techniques are still limited.

METHODS

This retrospective cohort study included patients who underwent total gastrectomy with D2 lymphadenectomy for gastric cancer between January 2016 and December 2021 at a single tertiary center. Patients were grouped as LTG or OTG. Propensity score matching (1:1) was used to adjust for baseline variables. Long-term clinical outcomes and survival data were compared. Complications were graded using the Clavien-Dindo classification. Kaplan-Meier analysis was used to evaluate disease-free survival (DFS) and overall survival (OS).

RESULTS

After propensity score matching (24 LTG vs. 24 OTG), the LTG group demonstrated a significantly shorter hospital stay (6.79 ± 0.66 vs. 7.33 ± 0.64 days; p = 0.006), with comparable operative times (3.5 ± 0.42 vs. 3.5 ± 0.49 h; p = 1.000) and complication rates (16.7% vs. 20.8%; p = 0.71), all classified as Clavien-Dindo Grade I-II. Oncologic outcomes showed equivalent lymph node yield. Oncologic outcomes were equivalent, including lymph node yield (35.12 ± 9.32 vs. 36.46 ± 10.19; p = 0.639). Survival analysis revealed no significant differences: median overall survival was 6 years (95% CI: 3.87-8.12) for LTG vs. 4 years (2.16-5.83) for OTG (p = 0.541), and disease-free survival was 6 years (4.53-7.46) vs. 4 years (1.72-6.27) (p = 0.443), with a median follow-up of 28.4 months.

CONCLUSION

Laparoscopic total gastrectomy is a safe and effective alternative to open surgery when performed by experienced surgeons. These findings support the feasibility of LTG in real-life clinical settings and complement existing evidence from randomized trials.

TRIAL REGISTRATION

retrospectively registered.