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Reduced anastomotic complications with intracorporeal esophagojejunostomy using endoscopic linear staplers (overlap method) in laparoscopic total gastrectomy for gastric carcinoma

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Abstract

Background

With advances in surgical technique and instrumentation, intracorporeal anastomosis is increasingly being performed for laparoscopic total gastrectomy (LTG). However, the benefits of intracorporeal anastomosis in reducing postoperative complications have not been demonstrated, although its technical feasibility has been proven in many studies. In this study, we investigated the impact of intracorporeal anastomosis in reducing postoperative complications after LTG.

Methods

We analyzed 410 consecutive gastric cancer patients who underwent LTG between 2008 and 2018. Of these, 118 underwent intracorporeal anastomosis using linear staplers (overlap method), while 292 underwent extracorporeal anastomosis using a circular stapler. Short-term surgical outcomes including postoperative complications were compared between the two groups.

Results

The two groups showed no significant differences in age, sex, comorbidity, and abdominal surgery history. D2 lymph node dissection was more frequently performed in the intracorporeal group because of the presence of more advanced cancer stages. The overall morbidity in the intracorporeal and extracorporeal group was 23.7% and 27.7%, respectively (p = 0.405). However, the intracorporeal group showed a significantly lower incidence of late complications (0.8% vs. 7.5%, p = 0.008). Concerning complications, the incidence of anastomotic bleeding (0% vs. 5.5%, p = 0.008) and anastomotic stenosis (0% vs. 4.5%, p = 0.024) was significantly lower in the intracorporeal group. In univariate and multivariate analyses, American Society of Anesthesiologists score and operative bleeding were independent predictive factors for postoperative complications in patients who underwent intracorporeal anastomosis.

Conclusions

Intracorporeal anastomosis using linear staplers reduced anastomotic bleeding and stenosis compared to extracorporeal anastomosis after LTG. Future research will be required to determine the ideal method for intracorporeal anastomosis in LTG.

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Funding

This study was supported by the grant (HCRI19016) from Chonnam National University Hwasun Hospital Institute for Biomedical Science.

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Authors and Affiliations

  1. Gastric Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea

    Oh Jeong, Mi Ran Jung, Ji Hoon Kang & Seong Yeob Ryu

  2. Department of Surgery, Chonnam National University School of Medicine, Hwasun-gun, South Korea

    Oh Jeong, Mi Ran Jung, Ji Hoon Kang & Seong Yeob Ryu

Authors
  1. Oh Jeong
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  2. Mi Ran Jung
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  4. Seong Yeob Ryu
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Correspondence to Seong Yeob Ryu.

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Drs. Oh Jeong, Seong Yeob Ryu, Mi Ran Jung, and Ji Hoon Kang have no conflicts of interest or financial ties to disclose.

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Jeong, O., Jung, M.R., Kang, J.H. et al. Reduced anastomotic complications with intracorporeal esophagojejunostomy using endoscopic linear staplers (overlap method) in laparoscopic total gastrectomy for gastric carcinoma. Surg Endosc 34, 2313–2320 (2020). https://doi.org/10.1007/s00464-019-07362-0

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