Optimization of Anastomotic Strategy in Totally Laparoscopic Gastric Cancer Surgery Based on Dynamic Inflammatory Response Trajectories: A Prospective Cohort Study

Objective Although laparoscopic surgery for gastric cancer has matured, the selection of the optimal anastomotic method (circular stapler [CS] vs. linear stapler [LS]) remains lacking in objective evidence based on patient biological responses. This study prospectively evaluated the dynamic changes in perioperative systemic inflammatory responses and their implications for guiding the choice of surgical approach (totally laparoscopic distal gastrectomy [TLDG] vs. totally laparoscopic total gastrectomy [LTG]) and anastomotic technique. Methods This prospective observational cohort study enrolled 180 patients undergoing radical laparoscopic gastrectomy. Patients were divided into four groups: TLDG-CS (n = 50), TLDG-LS (n = 50), LTG-CS (n = 40), and LTG-LS (n = 40). The CS groups underwent anastomosis using a novel laparoscopic purse-string suture clamp (Lap-PSC) combined with a multi-functional sealing cap (MSC). Serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) were measured preoperatively (T0), and at 24 hours (T1), 72 hours (T2), and 7 days (T3) postoperatively. The primary endpoint was the dynamic trajectory of inflammatory markers; secondary endpoints included surgical outcomes, postoperative recovery, and complications. Results Baseline characteristics were balanced among groups. Operative time was significantly shorter in the TLDG-CS group compared to TLDG-LS (148.3 ± 21.5 vs. 172.8 ± 28.4 minutes, p = 0.003). Inflammatory markers peaked at T1 and declined thereafter. At T2, IL-6 and hs-CRP levels were significantly lower in CS groups compared to LS groups for both TLDG and LTG (e.g., TLDG-CS vs. TLDG-LS IL-6: 82.4 ± 28.1 vs. 115.6 ± 35.7 pg/mL, p < 0.001). Multivariate linear regression confirmed that LS was an independent predictor of higher IL-6 (β = 28.4, 95%CI: 15.7–41.1, p < 0.001) and hs-CRP (β = 12.3, 95%CI: 6.8–17.8, p < 0.001) at T2. The overall anastomosis-related complication rate was significantly lower in the CS group (3.3% vs. 8.9%, p = 0.048). Conclusion Dynamic perioperative inflammatory responses are sensitive indicators of surgical trauma and prognosis. In totally laparoscopic gastric cancer surgery, circular stapling assisted by Lap-PSC and MSC significantly attenuates systemic inflammatory responses and is associated with a lower risk of anastomotic complications compared to linear stapling. Monitoring inflammatory dynamics may provide an objective biological basis for personalized surgical-anastomotic strategy selection, advancing gastric cancer surgery toward greater precision.