Katsuhiro Murakami1,2, Kazutaka Obama3,4, Shigeru Tsunoda1,2, Shigeo Hisamori1,2, Tatsuto Nishigori1,2, Koya Hida1,2, Seiichiro Kanaya5,2, Seiji Satoh6,2, Dai Manaka7,2, Michihiro Yamamoto8,2, Yoshio Kadokawa9,2, Atsushi Itami10,2, Hiroshi Okabe11,2, Hiroaki Hata12,2, Eiji Tanaka13,2, Yoshito Yamashita14,2, Masato Kondo15,2, Hisahiro Hosogi16,2, Nobuaki Hoshino1, Shiro Tanaka17, Yoshiharu Sakai1,2. 1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. 2. Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan. 3. Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. kobama@kuhp.kyoto-u.ac.jp. 4. Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan. kobama@kuhp.kyoto-u.ac.jp. 5. Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan. 6. Department of Gastroenterological Surgery and Oncology, Himeji Medical Center, Himeji, Japan. 7. Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan. 8. Department of Surgery, Shiga General Hospital, Moriyama, Japan. 9. Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan. 10. Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan. 11. Department of Surgery, Otsu City Hospital, Otsu, Japan. 12. Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 13. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan. 14. Department of Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. 15. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. 16. Department of Surgery, Kyoto City Hospital, Kyoto, Japan. 17. Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. METHODS: We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. RESULTS: After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p = 0.771). CONCLUSION: The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.
BACKGROUND: Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. METHODS: We collected data on 829 consecutive gastric cancerpatients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. RESULTS: After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p = 0.771). CONCLUSION: The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.
Entities:
Keywords:
Anastomotic stenosis; Circular stapler; Esophagojejunostomy; Linear stapler; Totally laparoscopic total gastrectomy
Authors: Tom Mala; Dag Førland; Caroline Skagemo; Tom Glomsaker; Hans Olaf Johannessen; Egil Johnson Journal: BMC Surg Date: 2022-04-09 Impact factor: 2.102
Authors: Jiadi Xing; Kai Xu; Maoxing Liu; Pin Gao; Fei Tan; Zhendan Yao; Nan Zhang; Hong Yang; Chenghai Zhang; Ming Cui; Xiangqian Su Journal: J Int Med Res Date: 2022-08 Impact factor: 1.573