Complications Following Open Versus Minimally Invasive Resection of Gastric Adenocarcinoma

Background and Objectives: Gastric adenocarcinoma (GA) is commonly treated with open or minimally invasive surgery (MIS). The preferred surgical approach remains unclear. This study sought to assess utilization over time, compare complication rates by surgical approach, and identify predictors of experiencing complications. Methods: Patients who underwent GA resection from 2016 to 2022 were identified in the American College of Surgeons National Surgical Quality Improvement Program and compared based on receipt of open gastrectomy versus MIS. Complication rates were compared with χ² tests. Predictors of experiencing complications or receiving MIS were assessed using multivariable Poisson regressions with robust variance. Results: Out of 4,429 patients, most underwent open gastrectomy versus MIS (84.2% vs. 15.9%). MIS uptake did not increase. Open gastrectomy patients experienced more major complications (18.5% vs. 13.1%), higher perioperative mortality (1.53% vs. 0.57%), and longer hospital stays (7 vs. 5 days) compared to MIS patients (all p values < 0.01). MIS patients had a decreased risk of experiencing any complications (RR: 0.7, 95% CI: 0.5–0.8). Non-white patients were less likely to receive MIS. Conclusions: MIS is associated with a decreased risk of experiencing complications compared to open gastrectomy for GA, yet its utilization has plateaued. Sociodemographic predictors of receipt of MIS indicate potential disparities in accessing certain treatments. Summary: The preferred surgical approach for gastric cancer is unclear. This analysis of the American College of Surgeons National Surgical Quality Improvement Program compared complication rates of open gastrectomy with minimally invasive surgery (MIS). MIS was associated with a decreased risk of experiencing complications, yet utilization has plateaued.