Laparoscopy-assisted gastrectomy remains safe and feasible for gastric cancer patients with a history of upper abdominal surgery

doi:10.3748/wjg.v32.i23.118489

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Jun 21, 2026; 32(23): 118489
Published online Jun 21, 2026. doi: 10.3748/wjg.v32.i23.118489

Table 1 Baseline characteristics of patients, n (%)

Characteristics	Overall cohort (unadjust)				PSM cohort				IPTW cohort
Characteristics	Laparoscopic (n = 83)	Open (n = 96)	P value	SMD	Laparoscopic (n = 74)	Open (n = 74)	P value	SMD	Laparoscopic (n = 70.35)	Open (n = 86.23)	P value	SMD
Age (year)	59.0 (52.0, 65.0)	58.5 (53.8, 64.0)	0.867	0.04	58.0 (52.0, 64.8)	58.0 (53.0, 64.0)	0.885	0.03	59.00 (52.0, 65.0)	58.00 (53.0, 64.0)	0.933	< 0.01
Sex			0.505	0.06	-		1.000	0.01	-
Female	33 (39.8)	44 (45.8)			30 (40.5)	31 (41.9)			28.26 (40.2)	36.70 (42.6)	0.756	0.05
Male	50 (60.2)	52 (54.2)			44 (59.5)	43 (58.1)			42.08 (59.8)	49.53 (57.4)	0.756	0.05
BMI (kg/m²)	23.6 (22.7, 25.4)	24.6 (23.2, 25.7)	0.424	0.15	23.6 (22.5, 25.4)	24.0 (22.4, 25.5)	0.775	0.06	23.60 (22.6, 25.4)	23.97 (22.6, 25.6)	0.718	0.07
ASA score			0.372	0.12	-		0.799	0.04	-
1	15 (18.1)	18 (18.8)			14 (18.9)	15 (20.3)			11.65 (16.6)	5.15 (17.6)	0.893	0.07
2	41 (49.4)	38 (39.6)			38 (51.4)	34 (45.9)			34.09 (48.5)	38.63 (44.8)	-	-
3	27 (32.5)	40 (41.7)			22 (29.7)	25 (33.8)			24.61 (35.0)	32.45 (37.6)	-	-
Neoadjuvant chemotherapy			1.000	0.01	-		0.838	0.03	-
No	69 (83.1)	79 (82.3)			60 (81.1)	58 (78.4)			57.90 (82.3)	70.87 (82.2)	0.984	< 0.01
Yes	14 (16.9)	17 (17.7)			14 (18.9)	16 (21.6)			12.45 (17.7)	15.36 (17.8)	-	-
cTNM stage			0.272	0.06	-		0.929	0.01	-		0.783	0.09
I	26 (31.3)	36 (37.5)			26 (35.1)	25 (33.8)			22.95 (32.6)	30.46 (35.3)
II	31 (37.3)	40 (41.7)			31 (41.9)	30 (40.5)			27.33 (38.8)	35.31 (41.0)
III	26 (31.3)	20 (20.8)			17 (23.0)	19 (25.7)			20.07 (28.5)	20.46 (23.7)

PSM: Propensity score matching; IPTW: Inverse probability of treatment weighting; SMD: Standardized mean difference; BMI: Body mass index; ASA: American Society of Anesthesiologists; cTNM: Clinical tumor-node-metastasis.

Full Size Table

Table 2 Details of previous surgical procedures, n (%)

Characteristics	Overall cohort (unadjust)			PSM cohort			IPTW cohort
Characteristics	Laparoscopic (n = 83)	Open (n = 96)	P value	Laparoscopic (n = 74)	Open (n = 74)	P value	Laparoscopic (n = 70.35)	Open (n = 86.23)	P value
Previous surgical approach			1.000	-	-	1.000	-	-	0.733
Laparoscopic	43 (51.8)	49 (51.0)		37 (50.0)	37 (50.0)		33.89 (48.2)	43.84 (50.9)
Open	40 (48.2)	47 (49.0)		37 (50.0)	37 (50.0)		36.46 (51.8)	42.38 (49.2)
Previous surgical procedures			0.816	-		0.744	-		0.698
Abdominal lesion resection¹	3 (3.61)	5 (5.21)	-	3 (4.05)	4 (5.41)	-	2.26 (3.21)	3.94 (4.57)
Cholecystectomy alone	23 (27.7)	20 (20.8)	-	19 (25.7)	15 (20.3)	-	20.53 (29.2)	17.73 (20.6)
Cholecystectomy and billary tract exploration	10 (12.0)	10 (10.4)	-	9 (12.2)	9 (12.2)	-	9.10 (12.9)	10.67 (12.4)
Colectomy	0 (0.00)	2 (2.08)	-	0 (0.00)	2 (2.70)	-	0.00 (0.00)	2.35 (2.73)
Distal pancreatectomy	3 (3.61)	4 (4.17)	-	1 (1.35)	4 (5.41)	-	2.03 (2.88)	3.80 (4.40)
Gastric lesion resection	9 (10.8)	12 (12.5)	-	8 (10.8)	10 (13.5)	-	7.62 (10.8)	10.85 (12.6)
Liver lesion resection	7 (8.43)	10 (10.4)	-	7 (9.46)	7 (9.46)	-	6.01 (8.55)	8.10 (9.39)
Repair of gastroduodenal perforation	14 (16.9)	10 (10.4)	-	13 (17.6)	7 (9.46)	-	11.69 (16.6)	9.07 (10.5)
Small intestine lesion resection	9 (10.8)	14 (14.6)	-	9 (12.2)	10 (13.5)	-	7.73 (11.0)	12.20 (14.2)
Splenectomy alone	5 (6.02)	9 (9.38)	-	5 (6.76)	6 (8.11)	-	3.37 (4.80)	7.51 (8.71)

¹Abdominal lesions were undiagnosed abdominal masses of unknown origin such as fibromatosis, liposarcoma, neurinoma, and tuberculosis of the abdominal cavity.

PSM: Propensity score matching; IPTW: Inverse probability of treatment weighting.

Full Size Table

Table 3 Surgical and pathological outcomes, n (%)

Characteristics	Overall cohort (unadjust)			PSM cohort			IPTW cohort
Characteristics	Laparoscopic (n = 83)	Open (n = 96)	P value	Laparoscopic (n = 74)	Open (n = 74)	P value	Laparoscopic (n = 70.35)	Open (n = 86.23)	P value
Surgical outcome
Surgical procedure	-		0.951	-		0.815	-		0.976
Proximal gastrectomy	19 (22.9)	22 (22.9)		12 (16.2)	15 (20.3)		14.69 (20.9)	18.41 (21.4)
Distal gastrectomy	44 (53.0)	49 (51.0)		43 (58.1)	41 (55.4)		37.78 (53.7)	44.87 (52.0)
Total gastrectomy	20 (24.1)	25 (26.0)		19 (25.7)	18 (24.3)		17.87 (25.4)	22.95 (26.6)
Operation time	229 (20.4)	214 (20.1)	< 0.001^a	229 (20.7)	212 (20.7)	< 0.001^a	230.00 (220, 240)	210.00 (200, 225)	< 0.001^a
Estimated blood loss	160 (140, 200)	180 (150, 200)	0.366	165 (150, 200)	180 (150, 200)	0.730	155.25 (140, 200)	180.00 (150, 200)	0.281
Conversion to open surgery¹			0.002^a	-		0.006^a	-		0.001^a
No	75 (90.4)	96 (100)		66 (89.2)	74 (100)		62.49 (88.8)	86.23 (100)
Yes	8 (9.64)	0 (0.00)		8 (10.8)	0 (0.00)		7.86 (11.2)	0.00 (0.00)
Iatrogenic injury²			0.803	-		0.743	-		0.502
No	77 (92.8)	91 (94.8)		68 (91.9)	70 (94.6)		64.90 (92.3)	81.76 (94.8)
Yes	6 (7.23)	5 (5.21)		6 (8.11)	4 (5.41)		5.45 (7.75)	4.47 (5.18)
Pathological outcome
R0 resection achieved	83 (100)	96 (100)	1.000	74 (100)	74 (100)	1.000	70.35 (100)	86.23 (100)	1.000
Total lymph node number	35.0 (27.0, 42.5)	35.0 (25.0, 38.5)	0.510	37.0 (28.0, 45.8)	34.5 (25.0, 37.8)	0.186	34.91 (26.69, 40.00)	35.00 (25.00, 38.10)	0.591
pTNM			0.668	-		0.762	-		0.708
I	31 (37.3)	33 (34.4)		27 (36.5)	26 (35.1)		25.39 (36.1)	28.04 (32.5)
II	25 (30.1)	35 (36.5)		22 (29.7)	26 (35.1)		21.88 (31.1)	32.14 (37.3)
III	27 (32.5)	28 (29.2)		25 (33.8)	22 (29.7)		23.09 (32.8)	26.05 (30.2)

^aP < 0.05.

¹Reasons for conversion to open surgery only included failure to place trocars and unseparated severe adhesion.

²Iatrogenic injury mainly included bowel injury, portal vein injury, and splenic bleeding.

PSM: Propensity score matching; IPTW: Inverse probability of treatment weighting; pTNM: Pathological tumor-node-metastasis.

Full Size Table

Table 4 Postoperative recovery and complications, n (%)

Characteristics	Overall cohort (unadjust)			PSM cohort			IPTW cohort
Characteristics	Laparoscopic (n = 83)	Open (n = 96)	P value	Laparoscopic (n = 74)	Open (n = 74)	P value	Laparoscopic (n = 70.35)	Open (n = 86.23)	P value
Time to first flatus	2.80 (2.60, 3.20)	3.35 (2.80, 3.60)	< 0.001^a	2.80 (2.60, 3.20)	3.30 (2.80, 3.50)	< 0.001^a	2.80 (2.60, 3.20)	3.39 (2.84, 3.60)	< 0.001^a
Time to first oral intake	2.80 (2.60, 3.30)	3.40 (2.88, 3.60)	< 0.001^a	2.80 (2.60, 3.30)	3.40 (2.80, 3.60)	0.001^a	2.80 (2.60, 3.30)	3.40 (2.90, 3.60)	< 0.001^a
Postoperative length of stay	9.00 (8.00, 10.0)	10.0 (9.00, 12.0)	< 0.001^a	9.00 (8.00, 10.0)	10.0 (9.00, 12.0)	< 0.001^a	9.00 (8.0, 10.0)	10.30 (9.0, 12.0)	< 0.001^a
Pain score on postoperative day 1	4.00 (4.00, 5.00)	5.00 (5.00, 6.00)	< 0.001^a	4.00 (4.00, 5.00)	6.00 (5.00, 6.00)	< 0.001^a	4.00 (4.00, 5.00)	5.26 (5.00, 6.00)	< 0.001^a
Pain score on postoperative day 2	2.00 (2.00, 3.00)	3.00 (2.00, 4.00)	0.002^a	2.00 (2.00, 3.00)	3.00 (2.00, 4.00)	0.003^a	2.00 (2.00, 3.00)	3.00 (2.00, 4.00)	0.007^a
Pain score on postoperative day 3	1.00 (0.00, 2.00)	1.00 (1.00, 2.00)	0.067	1.00 (0.00, 1.75)	1.00 (1.00, 2.00)	0.048^a	1.00 (0.00, 1.89)	1.00 (1.00, 2.00)	0.079
Complications¹			0.361	-		0.183	-		0.219
No	59 (71.1)	57 (59.4)	-	52 (70.3)	45 (60.8)	-	50.21 (71.4)	50.22 (58.2)	-
Anastomotic or duodenal stump leakage	3 (3.61)	3 (3.12)	-	3 (4.05)	1 (1.35)	-	2.47 (3.51)	2.05 (2.38)	-
Anastomotic bleeding	1 (1.20)	0 (0.00)	-	1 (1.35)	0 (0)	-	0.83 (1.18)	0.00 (0.00)	-
Intestinal obstruction	7 (8.43)	12 (12.5)	-	7 (9.46)	12 (16.2)	-	6.82 (9.70)	10.48 (12.6)	-
Lymphatic leakage	4 (4.82)	3 (3.12)	-	4 (5.41)	1 (1.35)	-	2.89 (4.11)	2.43 (2.81)	-
Gastrointestinal dysfunction	4 (4.82)	8 (8.33)	-	3 (4.05)	5 (6.76)	-	3.31 (4.70)	7.66 (8.88)	-
Incision infection	5 (6.02)	13 (13.5)	-	4 (5.41)	10 (13.5)	-	3.82 (5.42)	13.38 (15.5)	-
Re operation			1.000	-		1.000			0.740
No	79 (95.2)	91 (94.8)		70 (94.6)	71 (95.9)		65.90 (93.7)	81.84 (94.9)
Yes	4 (4.82)	5 (5.21)		4 (5.41)	3 (4.05)		4.45 (6.33)	4.38 (5.08)
Perioperative death			1.000	-		1.000	-		0.720
No	81 (97.6)	94 (97.9)		72 (97.3)	73 (98.6)		68.40 (97.2)	84.57 (98.1)
Yes	2 (2.41)	2 (2.08)		2 (2.70)	1 (1.35)		1.95 (2.77)	1.66 (1.92)
Textbook outcome	-		< 0.001^a	-		0.003^a	-		< 0.001^a
No	18 (21.7)	46 (47.9)		17 (23.0)	35 (47.3)		15.56 (22.1)	42.72 (49.6)
Yes	65 (78.3)	50 (52.1)		57 (77.0)	39 (52.7)		54.78 (77.9)	43.50 (50.5)

^aP < 0.05.

¹Postoperative complications mainly refer to surgery-related complications, including the seven conditions listed in the table. The diagnosis of all complications was based on one or more of the followings: The patient’s symptoms, physical examinations, laboratory tests (e.g., blood routine, drainage amylase and bilirubin tests, and bacterial culture and identification), upper gastrointestinal angiography, gastroscopy, and computed tomography examination.

PSM: Propensity score matching; IPTW: Inverse probability of treatment weighting.

Full Size Table

Table 5 Subgroup analysis of perioperative and pathological outcomes between laparoscopic and open surgery stratified by risk status

Characteristics	High risk group			Low risk group
Characteristics	Laparoscopic (n = 36)	Open (n = 38)	P value	Laparoscopic (n = 47)	Open (n = 58)	P value
Surgical procedure			0.972	-		0.818
Proximal gastrectomy	9 (25.0)	9 (23.7)		10 (21.3)	13 (22.4)
Distal gastrectomy	17 (47.2)	19 (50.0)		27 (57.4)	30 (51.7)
Total gastrectomy	10 (27.8)	10 (26.3)		10 (21.3)	15 (25.9)
Operation time	229 (18.7)	212 (18.9)	< 0.001^a	230 (21.8)	216 (20.9)	0.001^a
Estimated blood loss	180 (150, 200)	170 (150, 198)	0.127	150 (125, 200)	200 (150, 200)	0.037^a
Iatrogenic injury			0.610	-		1.000
No	34 (94.4)	37 (97.4)		43 (91.5)	54 (93.1)
Yes	2 (5.56)	1 (2.63)		4 (8.51)	4 (6.90)
Time to first flatus	2.80 (2.60, 3.20)	3.30 (2.82, 3.50)	0.008^a	2.80 (2.60, 3.20)	3.40 (2.82, 3.60)	< 0.001^a
Time to first oral intake	2.80 (2.60, 3.23)	3.30 (2.82, 3.58)	0.014^a	2.80 (2.60, 3.40)	3.50 (2.90, 3.70)	0.004^a
Postoperative length of stay	9.00 (8.00, 10.0)	10.0 (9.00, 11.8)	0.102	9.00 (8.00, 10.0)	11.0 (9.00, 13.0)	< 0.001^a
Pain score on postoperative day 1	4.00 (4.00, 5.00)	5.00 (5.00, 6.00)	< 0.001^a	4.00 (4.00, 5.00)	6.00 (5.00, 6.00)	< 0.001^a
Pain score on postoperative day 2	2.00 (2.00, 3.00)	2.50 (2.00, 3.75)	0.062	2.00 (2.00, 3.00)	3.00 (2.00, 4.00)	0.016^a
Pain score on postoperative day 3	1.00 (0.00, 1.00)	1.00 (1.00, 2.00)	0.065	1.00 (0.00, 2.00)	1.00 (1.00, 2.00)	0.419
Complications			0.527	-		0.614
No	24 (66.7)	20 (52.6)	-	35 (74.5)	37 (63.8)	-
Anastomotic or duodenal stump leakage	1 (2.78)	2 (5.26)	-	2 (4.26)	1 (1.72)	-
Anastomotic bleeding	1 (2.78)	0 (0.00)	-	0 (0.00)	0 (0.00)	-
Intestinal obstruction	4 (11.1)	4 (10.5)	-	3 (6.38)	8 (13.8)	-
Gastrointestinal dysfunction	1 (2.78)	4 (10.5)	-	3 (6.38)	4 (6.90)	-
Lymphatic leakage	2 (5.56)	1 (2.63)	-	2 (4.26)	2 (3.45)	-
Incision infection	3 (8.33)	7 (18.4)	-	2 (4.26)	6 (10.3)	-
Re operation			0.351	-		0.377
No	33 (91.7)	37 (97.4)		46 (97.9)	54 (93.1)
Yes	3 (8.33)	1 (2.63)		1 (2.13)	4 (6.90)
Perioperative death			1.000	-		0.586
No	36 (100)	37 (97.4)		45 (95.7)	57 (98.3)
Yes	0 (0.00)	1 (2.63)		2 (4.26)	1 (1.72)
R0 resection achieved	36 (100)	38 (100)		47 (100)	58 (100)
Total lymph node number	34.5 (19.5, 40.0)	34.0 (25.0, 38.0)	0.965	35.0 (28.0, 45.5)	35.0 (25.0, 40.0)	0.324
pTNM			0.609	-		0.804
I	12 (33.3)	13 (34.2)		19 (40.4)	20 (34.5)
II	11 (30.6)	15 (39.5)		14 (29.8)	20 (34.5)
III	13 (36.1)	10 (26.3)		14 (29.8)	18 (31.0)

^aP < 0.05.

PSM: Propensity score matching; IPTW: Inverse probability of treatment weighting; pTNM: Pathological tumor-node-metastasis.

Full Size Table

Citation: Wang P, Song YJ, Liu X, Jiang YJ, He Y, Song YB. Laparoscopy-assisted gastrectomy remains safe and feasible for gastric cancer patients with a history of upper abdominal surgery. World J Gastroenterol 2026; 32(23): 118489
URL: https://www.wjgnet.com/1007-9327/full/v32/i23/118489.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i23.118489

Wang P, Song YJ, Liu X, Jiang YJ, He Y, Song YB. Laparoscopy-assisted gastrectomy remains safe and feasible for gastric cancer patients with a history of upper abdominal surgery. World J Gastroenterol 2026; 32(23): 118489 [DOI: 10.3748/wjg.v32.i23.118489]

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