To investigate the clinical effect of totally laparoscopic distal gastrectomy (TLDG) in the treatment of locally advanced gastric cancer (LAGC).

A retrospective analysis was performed on the clinical data of LAGC patients from May 2021 to May 2023. Patients were divided into the TLDG group and the laparoscopic-assisted distal gastrectomy (LADG) group according to different surgical methods. Propensity score matching was used for 1:1 matching based on general data, with 60 patients enrolled in each group. Data were analyzed using SPSS 25.0 software. Measurement data such as perioperative indicators were expressed as (±s), and independent sample or paired sample t tests were used; enumeration data such as differentiation degree were expressed as (cases), and χ² test was applied; survival analysis was performed by Kaplan-Meier method with Log-Rank test. P<0.05 was considered statistically significant.

The TLDG group had less intraoperative blood loss and shorter incision length than the LADG group (P<0.05). The time to postoperative anal exhaust, feeding, ambulation, postoperative analgesic use, and hospital stay in the TLDG group were all shorter than those in the LADG group (P<0.05). The drainage tube removal time in the TLDG group was earlier than that in the LADG group, and the postoperative drainage volume was smaller (P<0.05). One day after surgery, the serum levels of IL-6, CRP, and WBC in both groups increased compared with those before surgery, but were lower in the TLDG group than in the LADG group (P<0.05). There was no significant difference in 1-year survival rate between the two groups (P>0.05).

TLDG shows good efficacy in the treatment of LAGC patients, with less intraoperative blood loss, shorter incision length, milder postoperative inflammatory response, and less drainage volume. It can shorten the postoperative recovery time, analgesic use time, and drainage tube removal time.