Skip to main content
SpringerLink
Log in

Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG.

Methods

We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups.

Results

After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p = 0.771).

Conclusion

The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ang TL, Fock KM (2014) Clinical epidemiology of gastric cancer. Singapore Med J 55:621–628

    Google Scholar 

  2. Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, Yamashita K, Watanabe M (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc 23:2416–2423

    Google Scholar 

  3. Xiong JJ, Nunes QM, Huang W, Tan CL, Ke NW, Xie SM, Ran X, Zhang H, Chen YH, Liu XB (2013) Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 19:8114–8132

    Google Scholar 

  4. Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z (2014) Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis. PLoS ONE 9:e88753

    Google Scholar 

  5. Kawamura H, Yokota R, Homma S, Kondo Y (2009) Comparison of invasiveness between laparoscopy-assisted total gastrectomy and open total gastrectomy. World J Surg 33:2389–2395

    Google Scholar 

  6. Kim HS, Kim BS, Lee IS, Lee S, Yook JH (2013) Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Technol A 23:323–331

    Google Scholar 

  7. Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, Ibanez L, Perez G, Pimentel F, Guzman S, Jarufe N, Boza C, Escalona A, Funke R (2012) Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 26:661–672

    Google Scholar 

  8. Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, Yoon HM, Cho SJ, Kook MC, Kim SJ (2012) Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 26:3273–3281

    Google Scholar 

  9. Bo T, Peiwu Y, Feng Q, Yongliang Z, Yan S, Yingxue H, Huaxing L (2013) Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study. J Gastrointest Surg 17:1202–1208

    CAS  Google Scholar 

  10. 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

    Google Scholar 

  11. Lu J, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M (2015) Short- and Long-term outcomes after laparoscopic versus open total gastrectomy for elderly gastric cancer patients: a propensity score-matched analysis. J Gastrointest Surg 19:1949–1957

    Google Scholar 

  12. Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, Haruta H, Hyodo M, Sata N, Lefor AT, Yasuda Y (2013) Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27:3683–3689

    Google Scholar 

  13. Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259:109–116

    Google Scholar 

  14. 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

    Google Scholar 

  15. Tsunoda S, Okabe H, Obama K, Tanaka E, Hisamori S, Kinjo Y, Sakai Y (2014) Short-term outcomes of totally laparoscopic total gastrectomy: experience with the first consecutive 112 cases. World J Surg 38:2662–2667

    Google Scholar 

  16. 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–e29

    Google Scholar 

  17. 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

    Google Scholar 

  18. 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

    Google Scholar 

  19. Usui S, Nagai K, Hiranuma S, Takiguchi N, Matsumoto A, Sanada K (2008) Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11:233–237

    Google Scholar 

  20. Kong SH, Suh Y, Kwon S, Lee HJ, Kim HH, Yang HK (2013) Stable purse-string suturing using an anterior esophagotomy for reconstruction with a circular stapler during laparoscopic total gastrectomy. Asian J Endosc Surg 6:82–89

    Google Scholar 

  21. Ali B, Park CH, Song KY (2017) Intracorporeal esophagojejunostomy using hemi-double-stapling technique after laparoscopic total gastrectomy in gastric cancer patients. Ann Surg Treat Res 92:30–34

    Google Scholar 

  22. Wang H, Hao Q, Wang M, Feng M, Wang F, Kang X, Guan WX (2015) Esophagojejunostomy after laparoscopic total gastrectomy by OrVil or hemi-double stapling technique. World J Gastroenterol 21:8943–8951

    Google Scholar 

  23. Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630

    Google Scholar 

  24. Kim JH, Choi CI, Kim DI, Kim DH, Jeon TY, Park DY (2015) Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy: a retrospective case-series study. World J Gastroenterol 21:2973–2981

    Google Scholar 

  25. 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

    Google Scholar 

  26. Chen K, Pan Y, Cai JQ, Xu XW, Wu D, Yan JF, Chen RG, He Y, Mou YP (2016) Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: a single-center 7-year experience. World J Gastroenterol 22:3432–3440

    Google Scholar 

  27. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101-112

  28. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Google Scholar 

  29. Satoh S, Okabe H, Kondo K, Tanaka E, Itami A, Kawamura J, Nomura A, Nagayama S, Watanabe G, Sakai Y (2009) Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer. Surg Endosc 23:436–437

    Google Scholar 

  30. Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211:e1–e6

    Google Scholar 

  31. Okabe H, Satoh S, Inoue H, Kondo M, Kawamura J, Nomura A, Nagayama S, Hasegawa S, Itami A, Watanabe G, Sakai Y (2007) Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy. Gastric Cancer 10:176–180

    Google Scholar 

  32. Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T, Akiyama Y, Wakabayashi G (2015) Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 38:102–112

    Google Scholar 

  33. 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 (OrVil()) versus linear stapler (overlap method). Surg Endosc 31:5175–5182

    Google Scholar 

  34. Sadahiro S, Morita S, Sasaki K, Sakamoto K, Ohge H, Takahashi T, Tsuchiya T, Sato T, Kondo K, Ogata Y, Masuko H, Baba H, Maeda K, Hamada M, Itabashi M, Nishimura G, Takahashi K, Ikeda M, Taguri M, Kodaira S (2015) Treatment rationale and study design for clinical trial on the efficacy of UFT/LV for stage II colorectal cancer with risk factors for recurrence (JFMC46-1201). Clin Colorectal Cancer 14:277–280

    Google Scholar 

  35. Blanchard P, Davis JW, Frank SJ, Kim J, Pettaway CA, Pugh TJ, Pisters LL, Ward JF, Choi S, Chapin BF, Hoffman K, Navai N, Achim M, McGuire SE, Matin SF, Nguyen Q, Mahmood U, Graber WJ, Chen HC, Wang X, Kuban DA (2018) Quality of life after brachytherapy or bilateral nerve-sparing robot-assisted radical prostatectomy for prostate cancer: a prospective cohort. BJU Int 121:540–548

    Google Scholar 

  36. Gould JC, Garren M, Boll V, Starling J (2006) The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 20:1017–1020

    Google Scholar 

  37. Fisher BL, Atkinson JD, Cottam D (2007) Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis 3:176–179

    Google Scholar 

  38. Finks JF, Carlin A, Share D, O’Reilly A, Fan Z, Birkmeyer J, Birkmeyer N (2011) Effect of surgical techniques on clinical outcomes after laparoscopic gastric bypass–results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis 7:284–289

    Google Scholar 

  39. Kyogoku N, Ebihara Y, Shichinohe T, Nakamura F, Murakawa K, Morita T, Okushiba S, Hirano S (2018) Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study. Langenbecks Arch Surg 403:463

    Google Scholar 

  40. 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

    Google Scholar 

  41. Jiang N, Deng JY, Ding XW, Zhang L, Liu HG, Liang YX, Liang H (2014) Effect of complication grade on survival following curative gastrectomy for carcinoma. World J Gastroenterol 20:8244–8252

    Google Scholar 

  42. Li QG, Li P, Tang D, Chen J, Wang DR (2013) Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol 19:4060–4065

    CAS  Google Scholar 

  43. Kawase H, Ebihara Y, Shichinohe T, Nakamura F, Murakawa K, Morita T, Okushiba S, Hirano S (2017) Long-term outcome after laparoscopic gastrectomy: a multicenter retrospective study. Langenbecks Arch Surg 402:41–47

    Google Scholar 

  44. Jeong O, Ryu SY, Choi WY, Piao Z, Park YK (2014) Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 21:2994–3001

    Google Scholar 

  45. Kang SY, Lee SY, Kim CY, Yang DH (2010) Comparison of Learning Curves and Clinical Outcomes between Laparoscopy-assisted Distal Gastrectomy and Open Distal Gastrectomy. J Gastric Cancer 10:247–253

    Google Scholar 

Download references

Acknowledgements

This paper was based on the previous communication to the 31st Annual Meeting of the Japan Society for Endoscopic Surgery. The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

This study was supported by operating support grants from Kyoto University (No. 021515).

Author information

Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Katsuhiro Murakami, Kazutaka Obama, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori, Koya Hida, Nobuaki Hoshino & Yoshiharu Sakai

  2. Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan

    Seiichiro Kanaya

  3. Department of Gastroenterological Surgery and Oncology, Himeji Medical Center, Himeji, Japan

    Seiji Satoh

  4. Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan

    Dai Manaka

  5. Department of Surgery, Shiga General Hospital, Moriyama, Japan

    Michihiro Yamamoto

  6. Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan

    Yoshio Kadokawa

  7. Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan

    Atsushi Itami

  8. Department of Surgery, Otsu City Hospital, Otsu, Japan

    Hiroshi Okabe

  9. Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Hiroaki Hata

  10. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan

    Eiji Tanaka

  11. Department of Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan

    Yoshito Yamashita

  12. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Masato Kondo

  13. Department of Surgery, Kyoto City Hospital, Kyoto, Japan

    Hisahiro Hosogi

  14. Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan

    Katsuhiro Murakami, Kazutaka Obama, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori, Koya Hida, Seiichiro Kanaya, Seiji Satoh, Dai Manaka, Michihiro Yamamoto, Yoshio Kadokawa, Atsushi Itami, Hiroshi Okabe, Hiroaki Hata, Eiji Tanaka, Yoshito Yamashita, Masato Kondo, Hisahiro Hosogi & Yoshiharu Sakai

  15. Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Shiro Tanaka

Authors
  1. Katsuhiro Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazutaka Obama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeru Tsunoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shigeo Hisamori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tatsuto Nishigori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koya Hida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seiichiro Kanaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seiji Satoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dai Manaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michihiro Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshio Kadokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Atsushi Itami
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hiroshi Okabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiroaki Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Eiji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yoshito Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Masato Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Hisahiro Hosogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Nobuaki Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Shiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Yoshiharu Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Katsuhiro Murakami and Kazutaka Obama designed the study, and Katsuhiro Murakami wrote the initial draft of the manuscript. Katsuhiro Murakami, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori, Koya Hida, Nobuaki Hoshino, and Shiro Tanaka contributed to analysis and interpretation of data. Kazutaka Obama assisted in the preparation of the manuscript. All other authors have contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Kazutaka Obama.

Ethics declarations

Disclosures

Drs. Katsuhiro Murakami, Kazutaka Obama, Shigeru Tsunoda, Shigeo Hisamori, Tatsuto Nishigori, Koya Hida, Seiichiro Kanaya, Seiji Satoh, Dai Manaka, Michihiro Yamamoto, Yoshio Kadokawa, Atsushi Itami, Hiroshi Okabe, Hiroaki Hata, Eiji Tanaka, Yoshito Yamashita, Masato Kondo, Hisahiro Hosogi, Nobuaki Hoshino, Shiro Tanaka, and Yoshiharu Sakai have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 26 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murakami, K., Obama, K., Tsunoda, S. et al. Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy. Surg Endosc 34, 5265–5273 (2020). https://doi.org/10.1007/s00464-019-07313-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07313-9

Keywords

Search

Navigation