{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:58:04Z","timestamp":1757620684356,"version":"3.44.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>While reduced-port laparoscopic gastrectomy(RPLG) has emerged as a minimally invasive alternative, its standardization and long-term efficacy remain underexplored. This study evaluates the comparative outcomes of three-port (TPLDG) versus five-port laparoscopic distal gastrectomy (FPLDG).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective multicenter study enrolled 355 gastric cancer patients meeting selection criteria. Surgical procedures adhered to D2 lymphadenectomy guidelines, with TPLDG utilizing a left-sided approach without auxiliary ports. Primary endpoints included inflammatory markers, recovery parameters, and 3-year survival outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The operative outcomes showed comparable results between groups, with similar operative times [140(125,160) <jats:italic>vs.<\/jats:italic> 135(120,150) minutes, <jats:italic>p<\/jats:italic>=0.068)] and total lymph node retrieved [(22(19,27) <jats:italic>vs.<\/jats:italic> 22(18,27) nodes, <jats:italic>p<\/jats:italic>=0.696)]. Notably, the TPLDG group demonstrated significant recovery advantages, including earlier flatus [(2(2,3) <jats:italic>vs.<\/jats:italic>3(2,3) days, <jats:italic>p<\/jats:italic>&amp;lt;0.001)], shorter hospital stays [4(3,5) <jats:italic>vs.<\/jats:italic> 5.2(4.2,6.3) days, <jats:italic>p<\/jats:italic>&amp;lt;0.001)], and reduced inflammatory responses as evidenced by lower postoperative CRP [(48.2 \u00b1 21.4) <jats:italic>vs.<\/jats:italic> (68.5 \u00b1 25.6) mg\/L, <jats:italic>p<\/jats:italic>&amp;lt;0.01)] and IL-6 levels [(82.3 \u00b1 31.2) <jats:italic>vs.<\/jats:italic> (115.4 \u00b1 38.5)pg\/mL, <jats:italic>p<\/jats:italic>&amp;lt;0.01)]. Importantly, oncological outcomes remained equivalent between groups, with comparable 3-year disease-free survival (85.4% vs 85.8%, <jats:italic>p<\/jats:italic>=0.85) and overall survival rates (89.4% vs. 89.2%, <jats:italic>p<\/jats:italic>=0.70), which were consistently maintained across stage-stratified analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TPLDG achieves comparable oncological outcomes to conventional FPLDG while offering significant advantages in postoperative recovery and inflammatory response reduction. The left-sided three-port technique represents a viable standardized approach for RPLG, particularly suited for D2 lymphadenectomy in Asian populations.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1627001","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T10:10:57Z","timestamp":1757326257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and efficacy of left-sided three-port laparoscopic gastric cancer surgery: a prospective observational 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