Totally laparoscopic distal gastrectomy with Billroth II: outcomes and quality of life in gastric adenocarcinoma

Introduction: to assess survival outcomes and quality of life (QoL) after totally laparoscopic distal gastrectomy (TLDG) with D2 lymphadenectomy and Billroth II reconstruction for gastric adenocarcinoma. Methods: a prospective cohort of 90 patients treated at Nghe An Friendship General Hospital (2021-2024) was analysed. Eligible patients (≥18 years, T1-T4a, M0, AJCC 8th) underwent TLDG with Billroth II. Overall survival (OS), disease-free survival (DFS), and QoL (Spitzer Index) were evaluated at 1, 6, 12, 24, and >24 months. Kaplan-Meier analysis and comparative statistics were applied. Results: the mean age was 65.5 years; males predominated (64.4%). Mean OS was 44.6 ± 1.3 months, with survival rates of 98.9%, 89.9%, and 78.8% at 12, 24, and 36 months. Mean DFS was 43.8 ± 1.5 months, with corresponding rates of 95.5%, 86.8%, and 78.8%. Sixteen patients (17.8%) died, including 14 (15.6%) from recurrence/metastasis. QoL scores remained favourable, averaging above 7 at all time points. Daily living and support domains scored highest, while health and self-evaluation were lowest. More than 85% of patients maintained QoL ≥7 throughout follow-up. At 24 months, male patients and those without comorbidities had significantly higher QoL scores (p < 0.05). Conclusion: TLDG with D2 lymphadenectomy and Billroth II reconstruction is safe, effective, and maintains good QoL, with 3-year OS and DFS rates above 78%. This minimally invasive approach offers oncologic adequacy and functional benefit, supporting its wider adoption in gastric cancer surgery.