Adopting Minimally Invasive Approaches for Managing Gastric Adenocarcinoma in a Low-Incidence Country Center: Feasibility and Limitations

Abstract

<title>Abstract</title> Backgroud Gastric adenocarcinoma (GA) remains a major cause of cancer-related mortality worldwide and is frequently diagnosed at an advanced stage in low-incidence countries. Although laparoscopic gastrectomy has become standard for early gastric cancer, its feasibility in locally advanced disease and in low-volume settings remains debated. This study aimed to evaluate the feasibility and short-term outcomes of laparoscopic gastrectomy in a low-incidence country with a high prevalence of locally advanced tumors. Methods We conducted a retrospective single-center study including all consecutive patients who underwent curative gastrectomy for histologically confirmed GA between January 2019 and December 2023. Patients were divided into laparoscopic (LG) and open gastrectomy (OG) groups. Intraoperative variables, postoperative complications (Clavien–Dindo classification), oncological outcomes, and 90-day mortality were compared. Results A total of 51 patients underwent curative resection, including 15 (29.4%) in the LG group. Most patients presented with locally advanced disease (T3–T4: 84.3%). Operative time was longer in the LG group but not significantly different from OG. Postoperative morbidity, reoperation rate, and 90-day mortality were comparable between the two groups. The LG group had a shorter postoperative hospital stay. Oncological outcomes, including R0 resection rate and number of lymph nodes retrieved, were similar between LG and OG. Conclusions In a low-incidence country with a high proportion of locally advanced gastric adenocarcinoma, laparoscopic gastrectomy appears to be a feasible and safe alternative to open surgery in selected patients, providing comparable short-term surgical and oncological outcomes with the potential benefit of faster postoperative recovery.