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Overlap method versus functional method for esophagojejunal reconstruction using totally laparoscopic total gastrectomy

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Abstract

Background

Laparoscopic intracorporeal esophagojejunostomy (EJ) is a useful method in totally laparoscopic total gastrectomy (TLTG) for treating upper-third gastric cancer. The two methods of laparoscopic intracorporeal EJ—functional and overlap—have not been compared side-by-side in terms of safety and feasibility.

Methods

Retrospective review and analysis of the data of 490 consecutive patients who underwent TLTG by either functional method (n = 365) or overlap (n = 125) method for upper- or middle-third gastric cancer was conducted between January, 2011 and May, 2018 at Asan Medical Center (Seoul, Korea). One-to-one propensity score matching (PSM) was performed to compare age, sex, body mass index, American Society of Anesthesiologist score, the presence of comorbidity, number of comorbidities, clinical T stage, clinical nodal stage, clinical TNM stage, history of previous abdominal surgery, and combined surgery. After PSM, 244 patients were divided into functional method group and overlap method group (n = 122, each). The surgical outcomes and EJ-related complications were compared between the two groups.

Results

No significant difference was found between the two groups in terms of early surgical outcomes such as operative time, time to first flatus, postoperative hospital stay, transfusion during surgery, transfusion after surgery, and administration of analgesics. However, the pain score was significantly lower in overlap method group (6.21 ± 1.83) than functional method group (6.97 ± 2.09, p < 0.05). The overlap method was also associated with significantly fewer late complications (3.28% vs. 12.30%; p < 0.05), lower Clavien–Dindo classification grade (p < 0.05), and fewer EJ-related complications (0.82% vs. 6.56%; p < 0.05), as compared with the functional method.

Conclusion

The overlap method was safer and more feasible than the functional method for TLTG in gastric cancer patients, based on the finding of significantly lower incidence of EJ-related complications.

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References

  1. 1.

    Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, Kim WH, Lee KU, Yang HK (2011) Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 98:255–260. https://doi.org/10.1002/bjs.7310

  2. 2.

    Blaser MJ, Saito D (2002) Trends in reported adenocarcinomas of the oesophagus and gastric cardia in Japan. Eur J Gastroenterol Hepatol 14:107–113. https://doi.org/10.1097/00042737-200202000-00003

  3. 3.

    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289. https://doi.org/10.1001/jama.265.10.1287

  4. 4.

    Steevens J, Botterweck AA, Dirx MJ, van den Brandt PA, Schouten LJ (2010) Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 22:669–678. https://doi.org/10.1097/MEG.0b013e32832ca091

  5. 5.

    Chen K, He Y, Cai JQ, Pan Y, Wu D, Chen DW, Yan JF, Maher H, Mou YP (2016) Comparing the short-term outcomes of intracorporeal esophagojejunostomy with extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. BMC Surg 16:13. https://doi.org/10.1186/s12893-016-0130-9

  6. 6.

    Kim HS, Kim MG, Kim BS, Yook JH, Kim BS (2012) Totally laparoscopic total gastrectomy using endoscopic linear stapler: early experiences at one institute. J Laparoendosc Adv Surg Tech A 22:889–897. https://doi.org/10.1089/lap.2012.0238

  7. 7.

    Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22:436–442. https://doi.org/10.1007/s00464-007-9446-y

  8. 8.

    Shim JH, Yoo HM, Oh SI, Nam MJ, Jeon HM, Park CH, Song KY (2013) Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 16:420–427. https://doi.org/10.1007/s10120-012-0207-9

  9. 9.

    Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23:2167–2171. https://doi.org/10.1007/s00464-008-9987-8

  10. 10.

    Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–29. https://doi.org/10.1016/j.jamcollsurg.2010.09.005

  11. 11.

    Kitagami H, Morimoto M, Nakamura K, Watanabe T, Kurashima Y, Nonoyama K, Watanabe K, Fujihata S, Yasuda A, Yamamoto M, Shimizu Y, Tanaka M (2016) Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Surg Endosc 30:4086–4091. https://doi.org/10.1007/s00464-015-4724-6

  12. 12.

    Lee TG, Lee IS, Yook JH, Kim BS (2017) Totally laparoscopic total gastrectomy using the overlap method; early outcomes of 50 consecutive cases. Surg Endosc 31:3186–3190. https://doi.org/10.1007/s00464-016-5343-6

  13. 13.

    The Union for International Cancer Control's What is TNM? https://www.uicc.org/resources/tnm. Accessed 27 Dec 2018

  14. 14.

    Japanese gastric cancer treatment guidelines (2014) ver. 4. Gastric Cancer 20:1–19. https://doi.org/10.1007/s10120-016-0622-4

  15. 15.

    Kim HS, Kim BS, Lee S, Lee IS, Yook JH, Kim BS (2013) Reconstruction of esophagojejunostomies using endoscopic linear staplers in totally laparoscopic total gastrectomy: report of 139 cases in a large-volume center. Surg Laparosc Endosc Percutan Tech 23:e209–216. https://doi.org/10.1097/SLE.0b013e31828e3b79

  16. 16.

    Gong CS, Kim BS, Kim HS (2017) Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience. World J Gastroenterol 23:8553–8561. https://doi.org/10.3748/wjg.v23.i48.8553

  17. 17.

    Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS (2013) Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 23:323–331. https://doi.org/10.1089/lap.2012.0389

  18. 18.

    Kim HS, Kim MG, Kim BS, Lee IS, Lee S, Yook JH, Kim BS (2013) Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy methods for the surgical treatment of early gastric cancer near the gastroesophageal junction. J Laparoendosc Adv Surg Tech A 23:204–210. https://doi.org/10.1089/lap.2012.0393

  19. 19.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

  20. 20.

    Robins JM, Hernan MA, Brumback B (2000) Marginal structural models and causal inference in epidemiology. Epidemiology 11:550–560. https://doi.org/10.1097/00001648-200009000-00011

  21. 21.

    Chen K, Pan Y, Cai JQ, Wu D, Yan JF, Chen DW, Yu HM, Wang XF (2016) Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol 14:96. https://doi.org/10.1186/s12957-016-0860-2

  22. 22.

    Chen K, Pan Y, Zhai ST, Yu WH, Pan JH, Zhu YP, Chen QL, Wang XF (2017) Totally laparoscopic versus open total gastrectomy for gastric cancer: a case-matched study about short-term outcomes. Medicine (Baltimore) 96:e8061. https://doi.org/10.1097/md.0000000000008061

  23. 23.

    Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R (2013) Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27:1509–1520. https://doi.org/10.1007/s00464-012-2661-1

  24. 24.

    Kunisaki C, Makino H, Takagawa R, Kimura J, Ota M, Ichikawa Y, Kosaka T, Akiyama H, Endo I (2015) A systematic review of laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 18:218–226. https://doi.org/10.1007/s10120-015-0474-3

  25. 25.

    Kawamura H, Ohno Y, Ichikawa N, Yoshida T, Homma S, Takahashi M, Taketomi A (2017) Anastomotic complications after laparoscopic total gastrectomy with esophagojejunostomy constructed by circular stapler (OrVilTM) versus linear stapler (overlap method). Surg Endosc 31:5175–5182. https://doi.org/10.1007/s00464-017-5584-z

  26. 26.

    Inokuchi M, Otsuki S, Fujimori Y, Sato Y, Nakagawa M, Kojima K (2015) Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 21:9656–9665. https://doi.org/10.3748/wjg.v21.i32.9656

  27. 27.

    Ebihara Y, Okushiba S, Kawarada Y, Kitashiro S, Katoh H (2013) Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy. Langenbecks Arch Surg 398:475–479. https://doi.org/10.1007/s00423-013-1051-z

  28. 28.

    Lee IS, Kim TH, Kim KC, Yook JH, Kim BS (2012) Modified techniques and early outcomes of totally laparoscopic total gastrectomy with side-to-side esophagojejunostomy. J Laparoendosc Adv Surg Tech A 22:876–880. https://doi.org/10.1089/lap.2012.0177

  29. 29.

    Sierzega M, Kolodziejczyk P, Kulig J (2010) Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 97:1035–1042. https://doi.org/10.1002/bjs.7038

  30. 30.

    Gong W, Li J (2017) Combat with esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer: a critical review of the literature. Int J Surg 47:18–24. https://doi.org/10.1016/j.ijsu.2017.09.019

  31. 31.

    Amin MB (2017) AJCC cancer staging manual, 8th edn. Springer, Chicago, IL

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Author information

CSK, CSG, BSK, and HSK performed literature search, conception and design, and drafting of the manuscript. SOK performed analysis and interpretation. All authors were involved in critical revision and final approval of the manuscript.

Correspondence to Hee Sung Kim.

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Chang Seok Ko, Chung Sik Gong, Byung Sik Kim, Seon Ok Kim, and Hee Sung Kim have no conflicts of interest or financial ties to disclose.

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Ko, C.S., Gong, C.S., Kim, B.S. et al. Overlap method versus functional method for esophagojejunal reconstruction using totally laparoscopic total gastrectomy. Surg Endosc (2020) doi:10.1007/s00464-020-07370-5

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Keywords

  • Laparoscopic surgery
  • Total gastrectomy
  • Esophagojejunostomy
  • Gastric cancer
  • Complication