Laparoscopic versus open gastrectomy for remnant gastric cancer: a meta-analysis of short-term and long-term outcomes

The safety, feasibility, and oncological outcomes of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for remnant gastric cancer (RGC) remain inconclusive. This meta-analysis aimed to compare the short- and long-term outcomes of LG and OG for RGC. A systematic literature search of the Cochrane Library, PubMed, and Embase was conducted from inception through August 19, 2026. Studies comparing LG with OG for RGC were included. Meta-analysis was performed using RevMan 5.4, with fixed-effects or random-effects models selected based on heterogeneity. Thirteen studies involving 780 patients were included: 265 in the laparoscopic group (LG) and 515 in the open group (OG). Compared with OG, LG was associated with a significantly longer operative time (mean difference [MD] = 56.61 min, 95% CI: 32.77–80.45; P < 0.0001), less intraoperative blood loss (MD =−272.24 mL, 95% CI:−407.66 to−136.81; P < 0.0001), shorter hospital stay (MD =−2.77 days, 95% CI:−4.31 to−1.24; P = 0.0004), earlier resumption of oral intake (MD =−1.66 days, 95% CI:−3.10 to−0.22; P = 0.02), and earlier passage of flatus (MD =−0.65 days, 95% CI:−0.83 to−0.46; P < 0.0001). The number of lymph nodes retrieved did not differ significantly between the two groups (MD = 2.22, 95% CI:−0.23 to 4.67; P = 0.08). LG was also associated with a significantly lower rate of overall complications (odds ratio [OR] = 0.68, 95% CI: 0.47–0.98; P = 0.04), whereas no significant difference was observed for severe complications (OR = 0.67, 95% CI: 0.36–1.23; P = 0.20). There were no significant differences in 5-year overall survival (hazard ratio [HR] = 1.09, 95% CI: 0.45–2.66; P = 0.85) or disease-free survival (HR = 5.50, 95% CI: 0.04–718.35; P = 0.49), although the evidence for a difference in DFS was weak. Laparoscopic gastrectomy improves short‑term recovery but prolongs operative time. Long‑term oncological equivalence lacks robust evidence.