Minimally Invasive Versus Open Total and Distal Gastrectomy After Chemotherapy for Gastric Cancer: A Nationwide Observational Study.

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.