Background <p>Current evidence on the surgical and oncological safety of laparoscopic surgery in patients with Borrmann type IV (B-IV) advanced gastric cancer (AGC) remains insufficient. This study aimed to compare the surgical and prognostic outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) in patients with B-IV AGC.</p> Methods <p>Patients with primary B-IV gastric cancer who underwent LG or OG between 2003 and 2019 were retrospectively analyzed. We conducted 1:1 propensity score matching using covariates including sex, age, body mass index, operation type, clinical T and N stages, pathological TNM stage, tumor size, and tumor location. Surgical outcomes, postoperative complications, 5-year survival and recurrence outcomes, and risk factors for peritoneal recurrence were compared between the two groups.</p> Results <p>Of 401 patients enrolled, 106 from each of the LG and OG groups were matched, with all standardized differences &lt; 0.1. The LG had significantly fewer wound infections (<i>P</i> = 0.029), intra-abdominal abscesses (<i>P</i> = 0.035) and a lower peritoneal recurrence rate (5-year cumulative incidence: 48.8% vs. 62.8%, <i>P</i> = 0.032; hazard ratio, 0.66; 95% confidence interval, 0.45–0.96) compared to the OG group, along with a trend toward improved 5-year overall survival (LG vs. OG: 37.0% vs. 26.2%, <i>P</i> = 0.174; hazard ratio, 0.78; 95% confidence interval, 0.55–1.11). Multivariate analyses revealed a 32.6% decrease in the hazard ratio for peritoneal recurrence in the LG group (<i>P</i> = 0.048).</p> Conclusions <p>LG significantly reduced peritoneal recurrence with fewer wound and intra-abdominal infectious complications in patients with B-IV AGC.</p> Graphical abstract <p></p>