Comparison of laparoscopic and open gastrectomy in gastric cancer: a randomized clinical trial on sufficiency of lymph node dissection and perioperative outcomes

To evaluate the oncological sufficiency and perioperative outcomes of laparoscopic versus open gastrectomy in patients with gastric adenocarcinoma, focusing on the sufficiency of lymph node dissection and short-term clinical results. This single-center, single-blind, randomized clinical trial included 40 patients with gastric adenocarcinoma, allocated equally to undergo either open or laparoscopic gastrectomy with standard D2 lymphadenectomy. The primary outcome was the total number of dissected lymph nodes. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, and length of hospital stay. Both groups were comparable in demographic and baseline clinical characteristics. The mean number of dissected lymph nodes was similar between open (25.5 ± 1.67) and laparoscopic (24.75 ± 2.12) groups ( p = 0.222), meeting oncologic adequacy criteria. Laparoscopic surgery resulted in significantly less blood loss (90.00 ± 13.82 mL vs. 128.00 ± 23.96 mL, p < 0.001) and shorter hospital stay (3.95 ± 0.68 days vs. 6.65 ± 0.93 days, p < 0.001), but required longer operative time (198.75 ± 26.25 min vs. 114.00 ± 18.93 min, p < 0.001). Postoperative complication rates were lower in the laparoscopic group (10.0% vs. 30.0%), though the difference was not statistically significant ( p = 0.235). Laparoscopic gastrectomy is a safe and effective alternative to open surgery for gastric cancer, achieving comparable lymphadenectomy with advantages in blood loss and recovery time. These findings support the oncological safety and perioperative benefits of the minimally invasive approach when performed by experienced surgeons.