腹腔镜胃切除在治疗局部晚期胃癌方面的使用越来越多，但仍存在疑虑，即与开放式胃切除相比，是否可以获得类似的结果，特别是在西方人群中。本研究基于瑞典食管和胃癌国家登记处的数据，比较了腹腔镜和开放式胃切除后的短期术后、肿瘤和生存结果。筛选了2015年至2020年间进行腺癌胃或胃食管交界Siewert III型的治疗性手术的患者，并包括622名cT2-4aN0-3M0肿瘤患者。使用多变量Logistic回归评估手术方法对短期结果的影响。使用多变量Cox回归比较长期生存率。其中，350名患者接受了开放式手术，272名接受了腹腔镜手术，其中12.9％被转为开放手术。两组患者的临床疾病阶段分布相似（27.6％为I期，46.0％为II期，26.4％为III期）。有52.7％的患者接受了新辅助化疗。术后并发症率无差异，但腹腔镜手术与90天死亡率较低有关（1.8％vs 4.9％，p = 0.043）。腹腔镜手术后切除淋巴结的中位数更高（32 vs 26,p<0.001），而在无肿瘤切缘切除率方面没有差异。腹腔镜胃切除后整体生存率较好（HR 0.63，p<0.001）。可安全地进行腹腔镜胃切除的治疗，并且与开放手术相比，腹腔镜胃切除与改善患者的整体生存率有关。©2023年作者（s）。

Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer.Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression.In total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001).Laparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.© 2023. The Author(s).