Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.117809
Revised: January 27, 2026
Accepted: February 25, 2026
Published online: May 27, 2026
Processing time: 138 Days and 4.5 Hours
Total laparoscopic distal gastrectomy (TLDG) is increasingly used for advanced gastric cancer, but its comprehensive outcomes vs open distal gastrectomy (ODG) require further validation.
To investigate the perioperative safety, postoperative recovery, and mid-term survival between TLDG and ODG for locally advanced gastric cancer.
This retrospective study analyzed patients admitted from January 2020 to January 2022. Patients were divided into TLDG and ODG groups on the basis of surgical approach. Perioperative outcomes, postoperative recovery, tumor pathology, preoperative and postoperative day 1 and 5 blood tests, complications, and 3-year overall survival and recurrence-free survival rates were evaluated.
A total of 420 patients were included, with 213 in the TLDG group and 207 in the ODG group. The TLDG group had shorter incision lengths (4.51 ± 0.52 cm vs 17.64 ± 3.25 cm, P < 0.001) and less blood loss (152.44 ± 26.55 mL vs 220.07 ± 21.58 mL, P < 0.001). Postoperative recovery was faster in the TLDG group, with earlier mobilization (1.85 ± 0.22 days vs 2.51 ± 0.24 days, P < 0.001), flatus (2.92 ± 0.24 days vs 3.52 ± 0.21 days, P < 0.001), and lower visual analog scale scores (postoperative day 5: 26.54 ± 4.20 vs 45.51 ± 10.41, P < 0.001). Inflammation was reduced in the TLDG group (postoperative day 1 white blood cell: 11.18 ± 2.11 × 109/L vs 11.81 ± 2.22 × 109/L, P = 0.003). Complication rates were similar, but the ODG group had more grade I–II complications (17.39% vs 10.33%, P = 0.036). Three-year overall survival (90.61% vs 90.34%, P = 0.924) and recurrence-free survival (80.28% vs 81.16%, P = 0.820) showed no significant differences.
Compared with ODG, TLDG for locally advanced cancer offers superior short-term outcomes in terms of reduced trauma, accelerated functional recovery, and pain relief without compromising oncological efficacy or survival rates.
Core Tip: This study demonstrates that totally laparoscopic distal gastrectomy for locally advanced gastric cancer provides short-term benefits over open distal gastrectomy, including reduced trauma, less blood loss, faster functional recovery, and lower pain scores, while achieving equivalent mid-term oncological outcomes. The 3-year overall survival and recurrence-free survival rates were comparable between the two techniques. Totally laparoscopic distal gastrectomy is a safe and effective minimally invasive alternative that does not compromise cancer control.