Laparoscopic versus open total gastrectomy for gastric cancer: A four-year single-center cohort with propensity score matching and risk factor analysis.

INTRODUCTION: Laparoscopic total gastrectomy (LTG) is increasingly used for gastric cancer, but its safety during implementation in Western practice remains debated, particularly regarding esophagojejunal leakage. This study compared short-term outcomes of LTG and open total gastrectomy (OTG) in a European cohort using propensity score matching. MATERIALS AND METHODS: This single-centre retrospective cohort included 198 consecutive patients who underwent curative-intent total gastrectomy with D2 lymphadenectomy for gastric adenocarcinoma between 2022 and 2025 (LTG, n = 112; OTG, n = 86). Propensity score matching based on age, sex, BMI, ASA class, neoadjuvant chemotherapy and clinical stage yielded 71 matched pairs. The primary endpoint was 30-day major morbidity (Clavien-Dindo ≥ IIIa). RESULTS: After matching, no statistically significant differences were observed in overall morbidity, major morbidity, 90-day mortality, or readmission. However, 90-day mortality was numerically higher after LTG (7.0% vs 1.4%), and esophagojejunal leakage was significantly more frequent after LTG (15.5% vs 4.2%, p = 0.046).Key surrogate oncological outcomes, including lymph node yield and R0 resection rate, were comparable. CONCLUSION: In this propensity score-matched European implementation cohort, LTG was associated with similar overall and major morbidity but a significantly higher esophagojejunal leakage rate and numerically higher 90-day mortality compared with OTG. Although surrogate pathological outcomes were comparable, these findings do not establish clinical equivalence between the two approaches and indicate that LTG implementation should remain cautious, structured, and subject to close monitoring of anastomotic safety.