Short- and Long-term Outcomes After Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer

Background/Aim: Total gastrectomy is the cornerstone treatment for gastric cancer, particularly in patients with proximal or large tumors. For early-stage gastric cancer, laparoscopic total gastrectomy (LTG) has demonstrated comparable short- and long-term outcomes to those of open total gastrectomy (OTG), while reports on advanced gastric cancer (AGC) are limited. We aimed to compare the short- and long-term outcomes of patients with AGC who underwent LTG or OTG. Patients and Methods: This study included consecutive patients with AGC who underwent LTG or OTG with lymph node dissection at our institution from January 2002 to June 2024. Propensity score matching was conducted at a 1:1 ratio to reduce bias. Results: A total of 158 patients were enrolled (LTG: 39; OTG: 119). Of these, 64 were paired by propensity score matching. The clinical tumor invasion depth was balanced, but the pathological depth was significantly deeper in the LTG group. The number of patients with lymph node metastasis did not differ. The median operative time was longer for LTG (512.5 min) than for OTG (267 min), whereas LTG resulted in significantly less blood loss (125 g vs. 411 g). Postoperative morbidity (≥Clavien‒Dindo grade 3) was comparable (LTG: 12.5%, OTG: 9.4%). The LTG group had a significantly shorter median hospital stay (11 days vs. 17 days). There were no significant differences in overall or recurrence-free survival between the groups. Conclusion: LTG is a feasible and safe approach for AGC, offering comparable short- and long-term outcomes to OTG.