Background  Old age is an independent risk factor for the postoperative complications after gastrectomy. In recent years, minimally invasive gastrectomy has become the optional surgical approach for elderly gastric cancer patients, but few studies focus on the indicators affecting postoperative complications after minimally invasive gastrectomy in the elderly.

  Objective  To analyze the short-term outcomes and factors influencing the postoperative complications of elder patients with gastric cancer under minimally invasive gastrectomy.

  Methods  From April 2017 to April 2021, a retrospective study was conducted for the clinical data about 492 elder patients aged ≥70 years undergoing minimally invasive gastrectomy (including 2D laparoscopic, 3D laparoscopy, or robotic gastrectomy) in the department of general surgery, the First Medical Center of Chinese PLA General Hospital. Binary logistic regression analysis was used to explore the factors associated with the 30-day postoperative complication occurrence.

  Results  Totally 103 patients (20.9%) had Clavien-Dindo classification ≥ grade Ⅱ postoperative complications, and 24 patients had Clavien-Dindo classification ≥ grade IIIa complications, with a serious complication rate of 4.9%. Two patients died before surgery (one patient with abdominal hemorrhage and the other with pulmonary embolism), with the mortality rate of 0.4%. Univariate analysis showed that vascular invasion, age ≥80 years, intraoperative blood loss ≥200 mL, and postoperative ICU transition were associated with the 30-day postoperative complications in elderly patients with gastric cancer under minimally invasive gastrectomy (P ＜ 0.05), while the minimally invasive surgical approaches (2D laparoscopic, 3D laparoscopic or robotic) were not significantly associated with the postoperative complication (P=0.096). Multivariate analysis showed that vascular invasion (OR=1.985; 95% CI: 1.267-3.110; P=0.003) and intraoperative blood loss≥200 mL (OR=2.120; 95% CI: 1.193-3.769, P=0.010) were independently associated with the 30-day postoperative complication in the elderly patients.

  Conclusion  Minimally invasive gastrectomy is safe and feasible for elderly patients. Vascular invasion and intraoperative blood loss ≥200 mL are associated with 30-day postoperative complication. For patients with above these factors, surgeons need to pay more attention to avoiding complications by sufficient preoperative evaluation.