Surgical Timing, Case Order, and Short-Term Outcomes After Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Retrospective Study

Background and Objectives: The associations between operative-day timing and outcomes after laparoscopic gastrectomy remain uncertain. This study evaluated surgical start time, daily case order, and inter-case interval in relation to short-term outcomes in patients with gastric cancer. Materials and Methods: This retrospective cohort study included 394 patients who underwent curative-intent laparoscopic gastrectomy at two tertiary centers between January 2016 and January 2026. Surgical start time was classified as morning (<12:00) or afternoon (≥12:00), and case order as first, second, or third. Among patients with available inter-case interval data, intervals were categorized as ≤30 or >30 min. Primary outcomes were 30-day postoperative complications and anastomotic leakage. Multivariable logistic regression was used to assess factors associated with postoperative complications. Results: Of the 394 procedures, 319 were performed in the morning and 75 in the afternoon. Afternoon procedures had higher unadjusted rates of conversion to open surgery (9.3% vs. 3.1%), postoperative complications (6.7% vs. 1.9%), and anastomotic leakage (5.3% vs. 0.9%). Across first, second, and third cases, complication rates were 1.5%, 3.7%, and 14.3%, respectively, and leakage rates were 0.8%, 2.8%, and 9.5%. Among 130 patients with interval data, leakage occurred in 7.6% after intervals > 30 min and in 0% after intervals ≤ 30 min. In the reported multivariable model, third versus first case order was associated with complications (odds ratio, 17.74; 95% confidence interval, 1.17–269.66). Conclusions: Later case order may be associated with postoperative complications; however, the limited number of postoperative events and wide confidence interval warrant cautious interpretation. These exploratory findings require validation before recommendations regarding surgical scheduling can be made.