Minimally Invasive Versus Open Total and Distal Gastrectomy After Chemotherapy for Gastric Cancer: A Nationwide Observational Study
In brief
After chemotherapy, minimally invasive gastrectomy linked to 9% to 22% fewer complications
In a nationwide observational study of 18,100 patients, minimally invasive surgery was associated with 9% fewer overall complications after total gastrectomy and 22% fewer after distal gastrectomy than open surgery. Wound infections and pancreatic fistulas were also less common with minimally invasive surgery in both groups. The findings support an association, but cannot establish that the surgical approach caused the difference.
- Journal
- Annals of gastroenterological surgery (Q1)
- Published
- 29 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Nobuaki Hoshino, Shinya Hirakawa, Shiogeo Hisamori, Hisateru Tachimori, Yusuke Fujii, Koshi Kumagai, et al.
- PMID
- 42819733
- DOI
- 10.1002/ags3.70287
Why clinicians should know about it
- Picked for Surgery (paper of the day, 6 October 2026): MIS associated with lower overall complication rates
Abstract
AIM: Minimally invasive surgery (MIS) is increasingly used for gastric cancer surgery. MIS is expected to facilitate surgical precision because of its magnified view, and facilitating identification of anatomical dissection layers is expected to reduce postoperative complications. To our knowledge, there is no consensus on the most appropriate surgical approach for gastric cancer following chemotherapy. METHODS: This nationwide, observational study used data from the National Clinical Database. Patients who underwent total gastrectomy (TG) or distal gastrectomy (DG) for gastric cancer after receiving chemotherapy between January 2014 and December 2022 were included. The incidence of overall complications of Clavien-Dindo (CD) grade ≥ 1 was set as the primary outcome, and the risk ratio (RR) was estimated using inverse probability of treatment weighting based on propensity scores and G-computation, comparing MIS and open surgery. The incidence of each complication was considered the secondary outcome. RESULTS: Overall, 18 100 patients were included in this study (TG, 9481; DG, 8619). MIS was associated with a lower incidence of overall complications of CD grade ≥ 1 in both TG (RR 0.91, 95% confidence interval [CI] 0.85-0.98) and DG (RR 0.78, 95% CI 0.72-0.84). MIS was also significantly associated with a lower incidence of superficial incisional surgical site infection (SSI), deep incisional SSI, and pancreatic fistulas in both gastrectomy groups. CONCLUSIONS: MIS was associated with lower rates of overall postoperative complications of CD grade ≥ 1, and wound-related complications and pancreatic fistulas than open surgery in patients with gastric cancer who underwent TG and DG after chemotherapy.
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.