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Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study

Surgical Endoscopy volume 28, pages 1929–1935 (2014)Cite this article

Abstract

Background

Although laparoscopic surgery is frequently performed for the treatment of gastric cancer, laparoscopic total gastrectomy is not widely performed because of its technical difficulty. Since December 2007 we have performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) in more than 110 cases in our institution by using a circular stapler with a trans-orally inserted anvil. We performed a single-center comparative study to evaluate the safety and efficacy of esophagojejunostomy using a trans-orally inserted anvil in patients who underwent TLTG for the treatment of gastric cancer.

Methods

In the present study, we examined 329 patients with gastric cancer who underwent esophagojejunostomy using a circular stapler after total gastrectomy. Data on the clinicopathological features, operative time, amount of intraoperative blood loss, and incidence of anastomosis-related complications among the surgical groups were obtained by reviewing the medical records, which were then analyzed.

Results

Approximately 67 % of the patients were men, and the average patient age was 64.0 years (range 26–93 years). In addition, 166 (50.5 %) and 163 (49.5 %) patients underwent open and laparoscopic surgery, respectively. Leakage following esophagojejunostomy was noted in 7 (4.2 %) of 166 patients who underwent total gastrectomy with open laparotomy, and 0 of 46 patients who underwent laparoscopic-assisted total gastrectomy (LATG). However, only 2 (1.7 %) of 117 patients who underwent TLTG using a trans-orally inserted anvil exhibited leakage following esophagojejunostomy. Anastomotic stenosis of the esophagojejunostomy was observed in 5 (3.0 %) of 166 patients who underwent total gastrectomy with open laparotomy, 2 (4.3 %) of 46 patients who underwent LATG, and 2 (1.7 %) of 117 patients who underwent TLTG using a trans-orally inserted anvil.

Conclusions

We believe that esophagojejunostomy using a trans-orally inserted anvil after TLTG for gastric cancer is a safe and useful surgical procedure.

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Acknowledgments

We are extremely grateful to all the patients, as well as the clinical staff who cared for these patients. We also thank Dr. Shigeharu Hamatani for his reliable pathological diagnoses.

Disclosures

Drs. Hiroaki Ito, Haruhiro Inoue, Noriko Odaka, Hitoshi Satodate, Manabu Onimaru, Haruo Ikeda, Daisuke Takayanagi, Kenta Nakahara, and Shin-ei Kudo have no conflicts of interest or financial ties to disclose.

Funding sources

This research received no specific grant from any public, commercial, or not-for-profit funding agency.

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Affiliations

  1. Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, 224-8503, Japan

    Hiroaki Ito, Haruhiro Inoue, Noriko Odaka, Hitoshi Satodate, Manabu Onimaru, Haruo Ikeda, Daisuke Takayanagi, Kenta Nakahara & Shin-ei Kudo

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  1. Hiroaki Ito
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  2. Haruhiro Inoue
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Correspondence to Hiroaki Ito.

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Ito, H., Inoue, H., Odaka, N. et al. Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study. Surg Endosc 28, 1929–1935 (2014). https://doi.org/10.1007/s00464-014-3417-x

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  • DOI: https://doi.org/10.1007/s00464-014-3417-x

Keywords

  • Gastric cancer
  • Trans-orally inserted anvil
  • Totally laparoscopic total gastrectomy
  • Laparoscopic gastrectomy
  • Open laparotomy
  • Esophagojejunostomy