Long-Term Outcomes of Minimally Invasive Total Gastrectomy for Locally Advanced Gastric Cancer

The oncologic safety of minimally invasive total gastrectomy (MITG) compared with open total gastrectomy (OTG) for locally advanced gastric cancer remains unclear. This study aimed to evaluate the long-term oncologic outcomes of MITG compared with OTG for locally advanced gastric cancer.

From 2007 to 2019, 1319 OTG and 348 MITG patients with locally advanced gastric cancer were retrospectively analyzed. The long-term oncologic outcomes of MITG and OTG were compared using propensity score-matching (PSM).

After PSM, clinicopathologic features were well-balanced. The MITG procedure showed less blood loss but a longer operative time. The rates of complications classified as Clavien-Dindo grade ≥III were comparable in the two groups (OTG 12.4% vs. MITG 10.6%; P = 0.470), including anastomotic leakage (OTG 2.9% vs. MITG 4.7%; P = 0.230). The 5 year overall survival rate was 83.0% in the OTG group (95% confidence interval [CI], 78.4-86.7%) and 87.3% in the MITG group (95% CI, 83.2-90.5%) (P = 0.398). The hazard ratio (HR) for death in the MITG group compared with the OTG group was 0.88 (95% CI, 0.61-1.27; P = 0.505). The 5-year relapse-free survival was 71.0% in the OTG group (95% CI, 64.8-76.4%) and 72.5% in the MITG group (95% CI, 66.6-77.5%) (P = 0.895). The HR for recurrence in the MITG group compared with the OTG group was 1.08 (95% CI, 0.80-1.46; P = 0.633).

For locally advanced gastric cancer, MITG demonstrated long-term oncologic outcomes similar to those of OTG. Therefore, MITG could be an oncologically safe option for locally advanced gastric cancer, although randomized studies are needed to confirm this finding.