Abstract Background Various anastomotic and reconstruction techniques are used to restore intestinal continuity after minimally invasive total (TG) and subtotal distal gastrectomy (DG). Aims Their effects on anastomotic leakage and postoperative morbidity have not been extensively studied. Methods Patients after minimally invasive TG and DG were selected from a cohort of 9356 oncological gastrectomies performed between 2017-2021 in 44 specialized centers. Results Three anastomotic techniques (circular stapled (CS, 3.7%); linear stapled (LS, 93.8%); hand sewn (HS, 2.5%)) and three types of bowel reconstruction (Roux (RX, 51.5%); Billroth I (BI, 23.1%); Billroth II (BII, 25.4%)) were identified after TG (n=878) and DG (n=3334). Postoperative morbidity was higher after TG compared to DG (AL 5.2% vs. 1.1%, p≤0.001; 90-day mortality 1.6% vs. 0.4%, p≤0.001; overall morbidity 28.6% vs. 16.3%, p≤0.001; major morbidity 15.4% vs. 8.0%, p≤0.001). Anastomotic leakage rate in the TG cohort was higher after CS (13.1%) and HS (7.9%) than after LS anastomoses (1.9%, p<0.001). Similarly, overall (CS: 43.9%, HS: 28.6%, LS: 23.1%) and major complications rates (CS: 25.2%, HS: 11.1%, LS: 12.0%) as well as mortality (CS: 4.7%, HS: 2.2%, LS: 0.8%) were higher after CS. Multivariate analysis confirmed anastomotic technique as a predictive factor for anastomotic leakage (Fig. 1), but not for occurrence of mortality, overall and major complications. In the DG cohort, most (98.7%), outcomes were similar for all types of bowel reconstruction: Anastomotic leakage (BI: 1.4%, BII 0.8%, RX 1.2%, p=0.440), 90-day mortality (BI: 0%, BII 0.1%, RY: 1.1%%, p=0.109), overall (BI: 14.5%, BII: 15.0%, RX: 18.7%, p=0.208) and major morbidity (BI: 7.9%, BII: 9.1%, RX: 7.2%, p=0.219). Conclusion In suitable situations, DG should be preferred to TG, as postoperative morbidity is significantly lower. In addition, LS should be the preferred method of anastomosis after TG. Conversely, the techniques for bowel reconstruction can be chosen according to the surgeon's preference.