Comparison of short-term outcomes and oncological outcomes between totally laparoscopic distal gastrectomy and pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: a non-inferiority randomized controlled trial

TLDG and TLPPG are safe and oncologically equivalent for EGC. TLPPG benefits postoperative nutrition and QOL by preserving pyloric function, despite a higher risk of delayed gastric emptying. Patient selection should consider tumor location, stage, and patient-specific needs, with TLPPG suitable for carefully selected early-stage cases to enhance functional outcomes. Long-term follow-up (ongoing at 3 years) is warranted to validate sustained benefits.