Impact of previous abdominal surgery on patients with gastric cancer undergoing minimally invasive gastrectomy: Evidence from 1851 participants

Background: Minimally invasive gastrectomy has become an important treatment option for gastric cancer. However, its safety and feasibility in patients with previous abdominal surgery (PAS) remain uncertain. PAS may lead to intra-abdominal adhesions, distorted anatomic planes, and greater technical difficulty during trocar placement, adhesiolysis, and lymph node dissection, which may in turn increase operative complexity and adversely affect perioperative outcomes. Current evidence on this issue remains inconsistent. Therefore, this study aimed to evaluate the effect of PAS on perioperative outcomes in patients undergoing minimally invasive gastrectomy for gastric cancer. Methods: Four databases were searched to find eligible studies from database inception to February 18, 2026. Comparative studies enrolling gastric cancer patients undergoing laparoscopic, laparoscopy-assisted, or robotic gastrectomy were included if they compared patients with PAS and those without PAS (non-PAS). The primary outcome was overall complications. Secondary outcomes included conversion to open surgery, intraoperative blood loss, operative time, lymph node yield, and length of hospital stay. Odds ratios (ORs) were calculated for dichotomous outcomes, and standardized mean differences (SMDs) were calculated for continuous outcomes, both with 95% confidence intervals (CIs), using random-effects models. Results: Six studies were included, comprising seven comparative cohorts with up to 1,851 patients. PAS was not associated with a significant increase in overall complications (OR = 1.21, 95% CI, 0.95–1.55; P = 0.12; I² = 0.0%). Likewise, no significant differences were observed in conversion to open surgery (OR = 1.75, 95% CI, 0.80–3.81; P = 0.16; I² = 0.0%), intraoperative blood loss (SMD = 0.05, 95% CI, − 0.05–0.15; P = 0.32; I² = 0.0%), or lymph node yield (SMD = 0.03, 95% CI, − 0.17–0.24; P = 0.74; I² = 5.4%). However, PAS was associated with a significantly longer operative time (SMD = 0.23, 95% CI, 0.03–0.43; P = 0.02; I² = 60.0%) and a slightly longer postoperative hospital stay (SMD = 0.10, 95% CI, 0.00-0.20; P = 0.04; I² = 0.0%). Conclusions: PAS might increase operative difficulty during minimally invasive gastrectomy for gastric cancer, mainly reflected by prolonged operative time and a slight increase in postoperative hospital stay.