Laparoscopic Versus Open D2 Gastrectomy for Gastric Cancer: A Case-Matched Comparative Study

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• The role of laparoscopic D2 gastrectomy for gastric cancer is debated.
• Comparing laparoscopic versus open resections is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare operative and short-term oncologic outcomes of laparoscopic versus open D2 gastrectomy for gastric cancer.
• To evaluate the safety and efficacy of the laparoscopic approach in potentially curative settings.

Main Methods:

• Retrospective review of patients undergoing potentially curative D2 gastrectomy (2017-2019).
• 1:1 matched analysis based on age and surgical extent (total/subtotal gastrectomy, additional organ resection).
• Intention-to-treat analysis including the learning curve for laparoscopic procedures.

Main Results:

• Laparoscopic surgery had longer operating times (393 vs. 218 minutes) but less blood loss (100 vs. 200 mL) and shorter hospital stays (3.0 vs. 7.5 days).
• No significant differences were observed in complication rates, mortality, readmissions, reoperations, lymph node retrieval, or R1 resection rates.
• One conversion from laparoscopic to open surgery occurred.

Conclusions:

• Laparoscopic D2 gastrectomy is associated with reduced operative trauma and quicker patient recovery.
• The laparoscopic approach provides equivalent oncologic resection compared to open surgery for gastric cancer.
• Laparoscopic D2 gastrectomy is a safe and effective option for selected patients with gastric cancer.