Oncologic and perioperative outcomes of laparoscopic versus open gastrectomy for T4a gastric cancer: A systematic review and meta-analysis
In brief
Laparoscopic gastrectomy shows similar five-year survival for T4a cancer
Across 13 studies, laparoscopic and open surgery had similar five-year overall and disease-free survival, with no overall difference in recurrence. Laparoscopy was linked to less blood loss and faster recovery, but longer operations and about twice the odds of pancreatic fistula; most evidence came from observational studies, so results support cautious use in selected patients at experienced centers.
- Journal
- Surgical oncology (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Maria Fernanda Queiroz Ferreira, Marcílio de Oliveira Filho, Bruno José de Queiroz Sarmento, Marcelo Henrique Ferreira Fernandes, Marcus Vinicius Ribeiro Padilha, Luciana Camara
- PMID
- 42800234
- DOI
- 10.1016/j.suronc.2026.102573
Why clinicians should know about it
- Picked for Surgery (paper of the day, 28 September 2026): Laparoscopic vs open gastrectomy for T4a gastric cancer
Abstract
BACKGROUND: The role of laparoscopic gastrectomy (LG) in T4a gastric cancer remains controversial because of concerns regarding oncologic adequacy and peritoneal dissemination. We compared LG with open gastrectomy (OG) in T4a gastric cancer. METHODS: PubMed, Embase, and Cochrane databases were searched from inception to February 2026. Primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Random-effects meta-analyses used hazard ratios (HR), odds ratios (OR), and mean differences (MD) with 95% confidence intervals (CI). RESULTS: Thirteen studies were included (2 randomized trials and 11 non-randomized cohorts). Five-year OS (HR 0.95, 95% CI 0.85-1.07) and DFS (HR 0.91, 95% CI 0.79-1.04) did not differ significantly overall; a gastrectomy-type interaction was observed for 5-year OS (P = 0.0041), with imprecise subgroup estimates. Total, peritoneal, and hematogenous/liver recurrence did not differ. Locoregional recurrence showed a significant gastrectomy-type interaction (P < 0.0001). LG was associated with less blood loss, earlier flatus and oral intake, shorter hospital stay, and longer operative time. Pancreatic fistula was more frequent after LG (OR 2.19, 95% CI 1.05-4.58); other major safety outcomes did not differ significantly. CONCLUSIONS: In selected patients with T4a gastric cancer, LG was associated with similar long-term survival and recurrence outcomes to OG, with faster recovery but more pancreatic fistula. These findings support LG as a reasonable option in experienced centers, while the predominantly observational evidence warrants cautious interpretation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.