Dynamic inflammatory responses guide anastomotic strategy in laparoscopic gastrectomy: a prospective cohort study

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. 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 h (T1), 72 h (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. 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 min, 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, adjusting for age, surgical type (LTG vs. TLDG), and operative time, 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). 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. These findings provide a biological basis to support the move toward more precise, patient-tailored surgical-anastomotic strategy selection.