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



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.


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.


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).


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.

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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 ( for the English language review.


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

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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.

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Correspondence to Kazutaka Obama.

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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.

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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).

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  • Totally laparoscopic total gastrectomy
  • Linear stapler
  • Circular stapler
  • Esophagojejunostomy
  • Anastomotic stenosis