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Laparoscopic versus Open Gastrectomy for T4a Gastric Cancer: A Systematic Review and Meta-Analysis of Oncologic and Perioperative Outcomes
Maria Fernanda Queiroz Ferreira1, Marcílio de Oliveira Filho2, Bruno José de Queiroz Sarmento3, Marcelo Henrique Ferreira Fernandes4, Marcus Vinicius Ribeiro Padilha5, Luciana Camara4 1Beth Israel Deaconess Medical Center, Boston, MA 2Faculdade de Medicina de Barbacena, Barbacena, Brazil 3Hospital de Base do Distrito Federal, Brasília, Brazil 4Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil 5UMass Chan Medical School, Worcester, MA
Background: The role of laparoscopic gastrectomy (LG) in T4a gastric cancer remains controversial, given concerns about oncologic adequacy and peritoneal dissemination. We compared LG with open gastrectomy (OG) in pathologically or clinically staged T4a disease. Methods: PubMed, Embase, and Cochrane databases were searched from inception to February 2026. Primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Random-effects meta-analyses were performed using hazard ratios (HR), odds ratios (OR), and mean differences (MD) with 95% confidence intervals (CI). Results: Thirteen studies were included, comprising two randomized trials and eleven non-randomized cohorts. Five-year OS (HR 0.95, 95% CI 0.85–1.07) and DFS (HR 0.91, 95% CI 0.79–1.04) were comparable. Total recurrence (OR 0.83, 95% CI 0.64–1.06), peritoneal recurrence (OR 0.94, 95% CI 0.68–1.30), and hematogenous/liver recurrence (OR 1.03, 95% CI 0.62–1.71) did not differ. Locoregional recurrence showed a significant interaction by gastrectomy type (P < 0.0001), precluding a single overall estimate. LG was associated with less blood loss (MD −33.46 mL), earlier flatus and oral intake, and shorter hospital stay, but longer operative time (MD 39.06 min). Lymph-node yield, overall morbidity, major complications, mortality, anastomotic leakage, and pulmonary complications were comparable. Pancreatic fistula was significantly more frequent after LG (OR 2.19, 95% CI 1.05–4.58). Conclusion: In T4a gastric cancer, LG achieved oncologic outcomes and overall perioperative safety comparable to OG, with faster recovery and no evidence of increased peritoneal recurrence, although pancreatic fistula was more frequent after LG.
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