J Gastric Cancer.  2019 Jun;19(2):193-201. 10.5230/jgc.2019.19.e17.

Intracorporeal Esophagojejunostomy Using a Circular or a Linear Stapler in Totally Laparoscopic Total Gastrectomy: a Propensity-Matched Analysis

Affiliations
  • 1Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. hhkim@snubh.org
  • 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
There is no consensus on the optimal method for intracorporeal esophagojejunostomy (EJ) in laparoscopic total gastrectomy (LTG). This study aims to compare 2 established methods of EJ anastomosis in LTG.
MATERIALS AND METHODS
A total of 314 patients diagnosed with gastric cancer that underwent LTG in the period from January 2013 to October 2016 were enrolled in the study. In 254 patients, the circular stapler with purse-string "Lap-Jack" method was used, and in the other 60 patients the linear stapling method was used for EJ anastomosis. After propensity score matching, 58 were matched 1:1, and retrospective data for patient characteristics, surgical outcome, and post-operative complications was reviewed.
RESULTS
The 2 groups showed no significant difference in age, body mass index, or other clinicopathological characteristics. After propensity score matching analysis, the linear group had shorter operating time than the circular group (200.3±62.0 vs. 244.0±65.5, P≤0.001). Early postoperative complications in the circular and linear groups occurred in 12 (20.7%) and 15 (25.9%, P=0.660) patients, respectively. EJ leakage occurred in 3 (5.2%) patients from each group, with 1 patient from each group needing intervention of Clavien-Dindo grade III or more. Late complications were observed in 3 (5.1%) patients from the linear group only, including 1 EJ anastomosis stricture, but there was no statistical significance.
CONCLUSIONS
Both circular and linear stapling techniques are feasible and safe in performing intracorporeal EJ anastomosis during LTG. The linear group had shorter operative time, but there was no difference in anastomosis complications.

Keyword

Stomach neoplasm; Laparoscopy; Gastrectomy; Surgical anastomosis

MeSH Terms

Anastomosis, Surgical
Body Mass Index
Consensus
Constriction, Pathologic
Gastrectomy*
Humans
Laparoscopy
Methods
Operative Time
Postoperative Complications
Propensity Score
Retrospective Studies
Stomach Neoplasms
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