Outcomes of Minimally Invasive Versus Open Gastrectomy for Gastric Cancer Surgery With Curative Intent

To compare postoperative events and oncologic results between minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in gastric cancer surgery. Evidence of the short- and long-term results of MIG is still limited. A population-based cohort study included all patients undergoing elective gastric cancer resection with curative intent between 2014 and 2021 across 39 centers belonging to the EURECCA Spanish Registry. Postoperative complications, 90-day mortality, and 5-year overall survival (OS) and disease-free survival (DFS) were analyzed in the groups of MIG and OG using propensity score matching (1:1). Subtotal gastrectomy (SG) vs. total gastrectomy (TG) was also assessed. A total of 1,333 matched-pair patients were included. The use of MIG increased significantly from 2017. The comparison of OG and MIG showed similar results for overall complications (47.4% vs. 44.7%), major complications (19.1 vs. 18.2%), 90-day mortality (4.4% vs. 3.2%), and failure to rescue (23.1% vs. 17.3%), but the MIG group showed significantly shorter median length of hospitalization (P < 0.001) in the overall study population (8 vs. 10 days) as well as in the subgroups of SG (7 vs. 8 days) and TG (10 vs. 11 days), and higher ≥ 15 nodes retrieval (84.2% vs. 78.8%, P < 0.001). Anastomotic leakage after TG was high (about 17%) and did not differ between surgical approaches. Also, MIG and OG showed similar 5-year OS (62% vs. 64.6%) and DFS (58.5% vs. 56.5%). The implementation of MIG did not increase complications and showed similar oncologic outcomes as compared with OG.