Impact of previous abdominal surgery on perioperative outcomes after minimally invasive gastrectomy for gastric cancer: an evidence synthesis and quantitative analysis

Previous abdominal surgery (PAS) may increase the technical difficulty of minimally invasive gastrectomy for gastric cancer because of postoperative adhesions and altered anatomy. However, its association with perioperative outcomes remains uncertain. This study aimed to compare perioperative outcomes between patients with and without PAS undergoing minimally invasive gastrectomy for gastric cancer. We conducted a systematic review and meta-analysis of comparative observational studies. Four databases were searched to find eligible studies from database inception to February 18, 2026. Studies comparing patients with and without PAS undergoing minimally invasive gastrectomy for gastric cancer were included. The primary outcome was overall postoperative complications. Secondary outcomes included conversion to open surgery, operative time, intraoperative blood loss, lymph node yield, and postoperative length of stay. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using ROBINS-E. Six studies comprising seven comparative cohorts and up to 1,851 patients were included. PAS was associated with longer operative time (MD = 11.17 min, 95% CI 3.80–18.54) and a small increase in postoperative length of stay (MD = 0.07 days, 95% CI 0.01–0.14). No statistically significant differences were observed in overall complications (OR = 1.21, 95% CI 0.95–1.55) or conversion to open surgery (OR = 1.75, 95% CI 0.80–3.81), although clinically important increases in these risks could not be excluded. No statistically significant differences were observed in intraoperative blood loss or lymph node yield. Previous abdominal surgery was associated with longer operative time and a small increase in postoperative hospital stay. Its impact on postoperative complications and conversion to open surgery remains uncertain, highlighting the need for individualized surgical planning.