BACKGROUND Total laparoscopic distal gastrectomy (TLDG) is increasingly used for advanced gastric cancer, but its comprehensive outcomes vs open distal gastrectomy (ODG) require further validation. AIM To investigate the perioperative safety, postoperative recovery, and mid-term survival between TLDG and ODG for locally advanced gastric cancer. METHODS This retrospective study analyzed patients admitted from January 2020 to January 2022. Patients were divided into TLDG and ODG groups on the basi