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

[BACKGROUND] 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.

[METHODS] 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).

[RESULTS] 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).

[CONCLUSION] 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.