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Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study

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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.

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Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Noriaki Kyogoku, Yuma Ebihara, Toshiaki Shichinohe & Satoshi Hirano

  2. Department of Surgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-ku, Sapporo, Hokkaido, Japan

    Fumitaka Nakamura

  3. Department of Surgery, Obihiro-Kosei General Hospital, West-6, South-8, Obihiro, Hokkaido, Japan

    Katsuhiko Murakawa

  4. Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan

    Takayuki Morita

  5. Department of Surgery, Tonan Hospital, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan

    Shunichi Okushiba

Authors
  1. Noriaki Kyogoku
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  2. Yuma Ebihara
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  3. Toshiaki Shichinohe
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  4. Fumitaka Nakamura
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  5. Katsuhiko Murakawa
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  6. Takayuki Morita
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  7. Shunichi Okushiba
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  8. Satoshi Hirano
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Contributions

Study conception and design: Noriaki Kyogoku and Yuma Ebihara. Acquisition of data: Noriaki Kyogoku, Fumitaka Nakamura, Katsuhiko Murakawa, Takayuki Morita, and Shunichi Okushiba. Analysis and interpretation of data: Noriaki Kyogoku. Drafting of manuscript: Yuma Ebihara. Critical revision of manuscript: Yuma Ebihara, Toshiaki Shichinohe, and Satoshi Hirano.

Corresponding author

Correspondence to Yuma Ebihara.

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Ethical standard

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki declaration of 1964 and its later versions. Informed consent for study inclusion was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.

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Kyogoku, N., Ebihara, Y., Shichinohe, T. et al. Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study. Langenbecks Arch Surg 403, 463–471 (2018). https://doi.org/10.1007/s00423-018-1678-x

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