Minimally Invasive Gastrectomy for Borrmann Type IV Gastric Cancer: An Oncologically Sound Alternative to Open Surgery

Abstract

Background. Previous studies have validated the oncologic safety of minimally invasive surgery (MIS) for advanced gastric cancer, but the feasibility of applying MIS to treat Borrmann type IV gastric cancer remains unclear. Given its distinct clinicopathological features, poor prognosis, and technical complexities in surgery, further investigation is needed. This study aimed to compare the surgical and oncological outcomes between open surgery and MIS in patients with Borrmann type IV gastric cancer. Methods. We retrospectively analyzed data from 1025 patients who underwent open (n = 888) or minimally invasive (n = 137) gastrectomy for Borrmann type IV gastric cancer between 2003 and 2021. Propensity score matching was performed to balance baseline characteristics, and short- and long-term outcomes were compared between the matched groups. Results. After propensity score matching, each group included 112 matched patients. The MIS group had longer operative times (p < 0.001) but shorter hospital stays (p < 0.001) than the open surgery group. Other perioperative outcomes showed no significant differences. Overall and recurrence-free survival were comparable between the two groups (p = 0.741 and p = 0.707, respectively). Adjusted hazard ratios for death and recurrence following MIS compared with open surgery were 1.20 (95% confidence interval 0.78-1.85, p = 0.396) and 1.22 (95% confidence interval 0.83-1.79, p = 0.308), respectively. Conclusion. Our findings suggest that MIS for Borrmann type IV gastric cancer may offer long-term oncologic outcomes comparable to those with open surgery while preserving the inherent benefits of MIS.