BACKGROUND: Minimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short-term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated. METHODS: We retrospectively compared short-term outcomes between MTG and OTG for locally advanced gastric and esophago-gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders. RESULTS: In total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien-Dindo classification (C-D) ≥3 than the OTG group (3.2% vs. 11.6%, CONCLUSIONS: MTG for locally advanced gastric cancer may provide improved short-term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.