Noriaki Kyogoku1, Yuma Ebihara2, Toshiaki Shichinohe1, Fumitaka Nakamura3, Katsuhiko Murakawa4, Takayuki Morita5, Shunichi Okushiba6, Satoshi Hirano1. 1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. 2. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. yuma-ebi@wc4.so-net.ne.jp. 3. Department of Surgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-ku, Sapporo, Hokkaido, Japan. 4. Department of Surgery, Obihiro-Kosei General Hospital, West-6, South-8, Obihiro, Hokkaido, Japan. 5. Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan. 6. Department of Surgery, Tonan Hospital, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan.
Abstract
PURPOSE: We used propensity score matching to compare the complication rates after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using a circular or a linear stapler. METHODS: We retrospectively enrolled all patients who underwent curative LTG between November 2004 and March 2016. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Clinicopathological characteristics and surgical outcomes were compared. RESULTS: We identified 66 propensity score-matched pairs among 379 patients who underwent LTG. There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. In the circular and linear groups, the rate of all complications (Clavien-Dindo [CD] classification ≥ I; 21 vs. 26%, respectively; p = 0.538), complications more severe than CD grade III (14 vs. 14%, respectively; p = 1.000), and occurrence of EJS leakage and stenosis more severe than CD grade III (5 vs. 2%, p = 0.301; 9 vs. 8%, p = 0.753, respectively) were comparable. CONCLUSIONS: There is no difference in the postoperative complication rate related to the type of stapler used for EJS after LTG.
PURPOSE: We used propensity score matching to compare the complication rates after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using a circular or a linear stapler. METHODS: We retrospectively enrolled all patients who underwent curative LTG between November 2004 and March 2016. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Clinicopathological characteristics and surgical outcomes were compared. RESULTS: We identified 66 propensity score-matched pairs among 379 patients who underwent LTG. There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. In the circular and linear groups, the rate of all complications (Clavien-Dindo [CD] classification ≥ I; 21 vs. 26%, respectively; p = 0.538), complications more severe than CD grade III (14 vs. 14%, respectively; p = 1.000), and occurrence of EJS leakage and stenosis more severe than CD grade III (5 vs. 2%, p = 0.301; 9 vs. 8%, p = 0.753, respectively) were comparable. CONCLUSIONS: There is no difference in the postoperative complication rate related to the type of stapler used for EJS after LTG.
Authors: Jai Young Cho; Ho-Seong Han; Yoo-Seok Yoon; Dae Wook Hwang; Kyuwhan Jung; Young Ki Kim Journal: World J Surg Date: 2013-09 Impact factor: 3.352