Background <p>Laparoscopic total gastrectomy (LTG) is increasingly performed for gastric cancer, yet concerns remain regarding its oncologic adequacy compared to open total gastrectomy (OTG), especially outside of randomized clinical trials. Real-world data comparing both techniques are still limited.</p> Methods <p>This retrospective cohort study included patients who underwent total gastrectomy with D2 lymphadenectomy for gastric cancer between January 2016 and December 2021 at a single tertiary center. Patients were grouped as LTG or OTG. Propensity score matching (1:1) was used to adjust for baseline variables. Long-term clinical outcomes and survival data were compared. Complications were graded using the Clavien-Dindo classification. Kaplan–Meier analysis was used to evaluate disease-free survival (DFS) and overall survival (OS).</p> Results <p>After propensity score matching (24 LTG vs. 24 OTG), the LTG group demonstrated a significantly shorter hospital stay (6.79 ± 0.66 vs. 7.33 ± 0.64 days; <i>p</i> = 0.006), with comparable operative times (3.5 ± 0.42 vs. 3.5 ± 0.49&#xa0;h; <i>p</i> = 1.000) and complication rates (16.7% vs. 20.8%; <i>p</i> = 0.71), all classified as Clavien-Dindo Grade I-II. Oncologic outcomes showed equivalent lymph node yield. Oncologic outcomes were equivalent, including lymph node yield (35.12 ± 9.32 vs. 36.46 ± 10.19; <i>p</i> = 0.639). Survival analysis revealed no significant differences: median overall survival was 6 years (95% CI: 3.87–8.12) for LTG vs. 4 years (2.16–5.83) for OTG (<i>p</i> = 0.541), and disease-free survival was 6 years (4.53–7.46) vs. 4 years (1.72–6.27) (<i>p</i> = 0.443), with a median follow-up of 28.4 months.</p> Conclusion <p>Laparoscopic total gastrectomy is a safe and effective alternative to open surgery when performed by experienced surgeons. These findings support the feasibility of LTG in real-life clinical settings and complement existing evidence from randomized trials.</p> Trial registration <p>retrospectively registered.</p>