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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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Authors and Affiliations

  1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Chang Seok Ko, Chung Sik Gong, Byung Sik Kim & Hee Sung Kim

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seon Ok Kim

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Contributions

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.

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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 35, 130–138 (2021). https://doi.org/10.1007/s00464-020-07370-5

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