Optimizing surgical outcomes in gastric cancer: a comparison of laparoscopic and open total gastrectomy

Background

The efficacy of the laparoscopic approach for total gastrectomy (TG) in Western countries remains under discussion. Recently, textbook outcome (TO) has gained recognition as a comprehensive measure of quality of care in upper gastrointestinal surgery. Although predictive factors for TO after TG are well documented, the influence of the surgical approach requires further analysis. This study aimed to compare the TO completion rate after TG for gastric cancer between the open (OTG) and laparoscopic TG (LTG) approaches.

Methods

TO was defined by 10 criteria: (1) absence of intraoperative complications, (2) macroscopically complete resection, (3) R0 margin, (4) retrieval of ≥15 lymph nodes, (5) absence of postoperative complications with Clavien-Dindo grade ≥ 2, (6) no surgical reintervention within 30 days, (7) no unplanned intensive care unit admission within 30 days, (8) no mortality within 30 days, (9) length of stay ≤ 21 days, and (10) no readmission within 30 days. Propensity score matching was used to adjust for potential selection bias. Predictive factors associated with TO were identified through univariate and multivariate analyses.

Results

Among the 188 patients, 34 underwent LTG. TO was achieved in 46.8% of cases, with no significant difference between OTG and LTG (45.5% vs 52.9%; P =.43). After propensity score matching, similar outcomes were observed (44.1% vs 52.9%; P =.47). However, LTG was associated with fewer postoperative complications of Clavien-Dindo grade ≥ 2 (P =.049), particularly pulmonary complications (P =.041).

Conclusion

This study confirms the feasibility and safety of LTG for cancer. The laparoscopic approach yields a TO completion rate comparable with that of the open approach while reducing postoperative complications.