Comparison of textbook outcomes between laparoscopic and open total gastrectomy for gastric cancer

While surgery remains an important part of the multimodal treatment of gastric cancer, laparoscopy is increasingly being used in these procedures. The aim of our study is to compare open and laparoscopic total gastrectomy using the concept of 'textbook outcome', which has become popular as an important and comprehensive tool in evaluating the quality of surgical treatment.

Gastric cancer patients underwent total gastrectomy with curative intent between July 2018 and January 2024 in a single center were included in this retrospective study. Exclusion criteria were emergency surgery, recurrent or metastatic disease, conversion to open, robotic gastrectomy. Patients divided to two groups as open and laparoscopic groups and compared in terms of demographic data, tumor characteristics, operative data and textbook outcome.

A total of 94 patients were enrolled in the study, while the majority of whom were male (73.4%, n = 69). Laparoscopic surgery was found longer but there was no significant difference in the incidence of anastomotic leak and other postoperative complications between the two groups. The textbook outcome rate was 50.8% in the open group while 51.5% in the laparoscopic total gastrectomy group (p = 0.949). The most significant variables associated with the inability to achieve the textbook outcome were readmissions, reinterventions and postoperative complications.

Achievement of textbook outcomes was found to be similar between the open and laparoscopic groups. Laparoscopic total gastrectomy can be safely preferred taking into account patient status, surgeon expertise and center conditions.