Perioperative Outcomes in Open Versus Minimally Invasive Gastrectomy For Gastric Cancer: A European Multicenter Study Based on the GASTRODATA Registry

Objective: To evaluate morbidity and mortality after minimally invasive (MIG) versus open gastrectomy (OG) for gastric cancer (GC) in a large European population, with a subgroup analysis comparing total and subtotal gastrectomy. Summary background data: Real-world European studies comparing postoperative outcomes between MIG and OG are lacking. Methods: This retrospective study included GC patients undergoing curative-intent gastrectomy between 2017 and 2021 at 24 high-volume European centers participating in the GASTRODATA registry. The primary outcome was the perioperative complication rate after MIG versus OG. Propensity score matching (PSM) was performed to adjust for potential confounders. Results: Of 2430 patients, 1,800 (74%) underwent OG and 630 (26%) MIG. MIG was performed in patients with smaller tumors, earlier stages, and less frequently receiving neoadjuvant treatment (P<0.001). MIG was associated with higher R0 resection rate (96.5% vs. 92.4% in OG), shorter hospital stay, lower perioperative complication rate (23.0% vs. 31.6%, P<0.001), and reduced 30-day and 90-day mortality rates (1.6% vs. 3.3%, [P=0.026] and 1.9% vs. 4.7%, [P=0.001], respectively). In sub-group analysis, MIG had fewer perioperative complications in subtotal (17.9% vs. 25.3%, P=0.005), but not total gastrectomy (31.5% vs. 36.1%, P=0.201). After PSM, MIG remaind significantly associated with lower perioperative complication rates compared to OG only in subtotal (OR=0.49, 95% CI, 0.30-0.80; P=0.005), but not in total gastrectomy (OR=1.15, 95% CI, 0.62-2.17; P=0.645). Conclusions: Minimally invasive subtotal gastrectomy was associated with fewer perioperative complications than OG, while this association was not observed for total gastrectomy. Minimally invasive subtotal gastrectomy should be considered a viable option in specialized European centers.