To explore the application effects of the intermediate approach and the left anterior approach in laparoscopic radical resection for advanced gastric cancer (AGC) in middle-aged and elderly patients.

The data of 91 middle-aged and elderly patients with localized AGC who underwent laparoscopic radical resection from January to December 2022 were retrospectively analyzed. The patients were grouped according to the surgical approach. 46 patients in the intermediate group received the intermediate approach; 45 patients in the left anterior group received the left anterior approach. Data were analyzed using SPSS 25.0 software. Quantitative data were expressed as (±s), and independent sample t test were used; count data were expressed as [cases (%)], and χ² tests or Fisher’s exact tests were performed; survival analysis was conducted using the Kaplan-Meier method. P<0.05 was considered statistically significant.

There were no statistically significant differences in the number of lymph node dissections during the operation, 24-hour postoperative serum C-reactive protein (CRP), superoxide dismutase (SOD) levels, and complication rates between the two groups (P>0.05); the operation time and intraoperative blood loss of the intermediate group were less than those of the left anterior group (P<0.05). Before closure, the serum dopa decarboxylase (DDC) and carcinoembryonic antigen (CEA) levels of the intermediate group were lower than those of the left anterior group (P<0.05); the 3-year recurrence rate of the intermediate group was lower than that of the left anterior group (P<0.05). The 3-year overall survival rate of the intermediate group was 87.0%, which was higher than that of the left anterior group (68.9%), and the disease-free survival period and overall survival period were longer than those of the left anterior group (P<0.05).

The intermediate approach and the left anterior approach laparoscopic radical resection for AGC in middle-aged and elderly patients have no statistically significant differences in the number of lymph node dissections during the operation, postoperative stress response, and complications. However, compared with the left anterior approach, the intermediate approach has shorter operation time, less intraoperative blood loss, lower 3-year recurrence rate, and longer disease-free survival period and overall survival period.