Outcomes of Minimally Invasive Versus Open Gastrectomy for Gastric Cancer Surgery With Curative Intent: A Population-Based Cohort Study.

Objective: To compare postoperative events and oncologic results between minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in gastric cancer surgery.

Background: Evidence of the short- and long-term results of MIG is still limited.

Methods: 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.

Results: 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%).

Conclusions: The implementation of MIG did not increase complications and showed similar oncologic outcomes as compared with OG.