Background  Laparoscopy-assisted radical gastric cancer surgery has become the main method of gastric cancer surgery today. With the development of imaging technology, 3D laparoscopy emerges after 2D and has gradually been used in clinics, but is laparoscopic surgery better than open surgery, is 3D more advantageous than 2D laparoscopy? This study is to explore this issue.

  Objective  To compare the difference of postoperative complications after 2D laparoscopic, 3D laparoscopic and open radical gastric cancer surgery.

  Methods  Clinical data about patients who underwent 2D laparoscopic, 3D laparoscopy or open radical gastric cancer surgery from January 1, 2018 to January 1, 2020 in the First Medical Centre of Chinese PLA General Hospital were retrospectively analyzed. All included patients were preoperatively diagnosed with primary gastric cancer and confirmed without distant metastasis, and they were confirmed with R0 resection by postoperative pathology. Patients without complete medical records were excluded. The postoperative complications among open group, 2D laparoscopic group and 3D laparoscopic group were analyzed and compared. One-way ANOVA was used to analyze continuous variables, while χ2 test or Fisher's exact test was chosen to compare categorical variables.

  Results  A total of 1 743 patients (1 324 males and 419 females) were included in this study, aged from 21 to 88 (59.7 ± 11.2) years. There were 400 cases (315 males and 85 females, 198 cases with age over 65 years) in open group, 589 cases (443 males and 146 females, 284 cases with age over 65 years) in 2D laparoscopic group and 754 cases (566 males and 188 females, 303 cases with age over 65 years) in 3D laparoscopic group. No statistically significant difference was found in the baseline data and some operative or postoperative data among three groups, such as gender, family history of tumors and preoperative radio chemotherapy, combined organ resection, surgical procedures or tumor stage (all P＞0.05). The incidence of postoperative complications among open group, 2D laparoscopic group and 3D laparoscopic group were 9.8% (39/400), 14.8% (87/589) and 11.4% (86/754), respectively (P=0.042). The incidence of anastomotic leakage was significantly higher in the 2D laparoscopic group and 3D laparoscopic group than that in the open group (4.8% 28/589 and 3.8%29/754 vs 1.3%5/400, P=0.012). The incidence of anastomotic bleeding in open group was lower than that of 2D laparoscopic group and 3D laparoscopic group (0.3%1/400 vs 1.7%10/589 and 0.4% 3/754, P=0.017. In view of Clavien-Dindo classification, III b complications occurred more common in open group (3.8% 15/400 vs 2D 1.2% 7/589 and 3D 1.2% 9/754, P=0.003).

  Conclusion  Open radical gastrectomy has no significant difference in types of complications compared with laparoscopic surgeries. However, the incidence of complication in laparoscopic surgery is higher than that of open radical gastrectomy. Patients undergoing laparoscopic surgery are more prone to have postoperative anastomotic leakage, and patients in 2D laparoscopic surgery group are more prone to have postoperative anastomotic bleeding, while open radical gastrectomy usually requires reintervention of general anesthesia.