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Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage I proximal gastric cancer: results of a single-arm multicenter phase II clinical trial in Korea, KLASS 03

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Abstract

Background

Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ).

Methods

The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups.

Results

There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020).

Conclusions

The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.

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References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  Google Scholar 

  2. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880. https://doi.org/10.1016/j.jamcollsurg.2006.02.028

    Article  PubMed  Google Scholar 

  3. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727. https://doi.org/10.1097/SLA.0b013e318185e62e

    Article  PubMed  Google Scholar 

  4. Kawamura H, Yokota R, Homma S, Kondo Y (2010) Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy. Surg Endosc 24:2739–2742. https://doi.org/10.1007/s00464-010-1037-7

    Article  PubMed  Google Scholar 

  5. Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G (2010) Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc 24:2860–2870. https://doi.org/10.1007/s00464-010-1067-1

    Article  PubMed  Google Scholar 

  6. Yoo HM, Lee HH, Shim JH, Jeon HM, Park CH, Kim JG, Song KY (2011) Long-term outcomes and survival after laparoscopy-assisted distal gastrectomy for gastric cancer: three-year survival analysis of a single-center experience in Korea. J Surg Oncol 104:511–515. https://doi.org/10.1002/jso.21982

    Article  PubMed  Google Scholar 

  7. Lee JH, Park do J, Kim HH, Lee HJ, Yang HK, (2012) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien-Dindo classification. Surg Endosc 26:1287–1295. https://doi.org/10.1007/s00464-011-2027-0

    Article  PubMed  Google Scholar 

  8. Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52. https://doi.org/10.1097/SLA.0b013e3182583e2e

    Article  PubMed  Google Scholar 

  9. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234. https://doi.org/10.1007/s101209900041

    Article  PubMed  Google Scholar 

  10. Kunisaki C, Makino H, Takagawa R, Kimura J, Ota M, Ichikawa Y, Kosaka T, Akiyama H, Endo I (2015) A systematic review of laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 18:218–226. https://doi.org/10.1007/s10120-015-0474-3

    Article  PubMed  Google Scholar 

  11. Okabe H, Tsunoda S, Tanaka E, Hisamori S, Kawada H, Sakai Y (2015) Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes. Surg Today 45:549–558. https://doi.org/10.1007/s00595-014-0901-9

    Article  PubMed  Google Scholar 

  12. 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. https://doi.org/10.1371/journal.pone.0088753

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hiyoshi Y, Oki E, Ando K, Ito S, Saeki H, Morita M, Baba H, Maehara Y (2014) Outcome of esophagojejunostomy during totally laparoscopic total gastrectomy: a single-center retrospective study. Anticancer Res 34:7227–7232

    PubMed  Google Scholar 

  14. Ichikawa D, Komatsu S, Kubota T, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2015) Evaluation of the safety and feasibility of laparoscopic total gastrectomy in clinical stage I gastric cancer patients. World J Surg 39:1782–1788. https://doi.org/10.1007/s00268-015-3008-6

    Article  PubMed  Google Scholar 

  15. Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY (2009) Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 146:469–474. https://doi.org/10.1016/j.surg.2009.03.023

    Article  PubMed  Google Scholar 

  16. 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. https://doi.org/10.1245/s10434-014-3666-x

    Article  PubMed  Google Scholar 

  17. Kim KH, Kim YM, Kim MC, Jung GJ (2013) Is laparoscopy-assisted total gastrectomy feasible for the treatment of gastric cancer? A case-matched study. Dig Surg 30:348–354. https://doi.org/10.1159/000354653

    Article  PubMed  Google Scholar 

  18. Nakata K, Nagai E, Ohuchida K, Shimizu S, Tanaka M (2015) Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes. Surg Endosc 29:1817–1822. https://doi.org/10.1007/s00464-014-3870-6

    Article  PubMed  Google Scholar 

  19. 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. https://doi.org/10.1007/s00268-014-2611-2

    Article  PubMed  Google Scholar 

  20. 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. https://doi.org/10.3748/wjg.v21.i32.9656

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ, Kwon OK, Kong SH, Kim HI, Lee HJ, Kim W, Ryu SW, Jin SH, Oh SJ, Ryu KW, Kim MC, Ahn HS, Park YK, Kim YH, Hwang SH, Kim JW, Cho GS (2018) A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer 22:214–222. https://doi.org/10.1007/s10120-018-0864-4

    Article  CAS  PubMed  Google Scholar 

  22. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 ver. 3. Gastric Cancer 14:113–123. https://doi.org/10.1007/s10120-011-0042-4

    Article  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  24. 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:e25–29. https://doi.org/10.1016/j.jamcollsurg.2010.09.005

    Article  PubMed  Google Scholar 

  25. Degiuli M, Sasako M, Ponti A, Italian Gastric Cancer Study Group (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97:643–649. https://doi.org/10.1002/bjs.6936

    Article  CAS  PubMed  Google Scholar 

  26. Pacelli F, Papa V, Rosa F, Tortorelli AP, Sanchez AM, Covino M, Bossola M, Doglietto GB (2008) Four hundred consecutive total gastrectomies for gastric cancer: a single-institution experience. Arch Surg 143:769–775. https://doi.org/10.1001/archsurg.143.8.769.(discussion 775)

    Article  PubMed  Google Scholar 

  27. Oh SJ, Hyung WJ, Li C, Song J, Kang W, Rha SY, Chung HC, Choi SH, Noh SH (2009) The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol 99:275–280. https://doi.org/10.1002/jso.21229

    Article  PubMed  Google Scholar 

  28. Yu W, Choi GS, Chung HY (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93:559–563. https://doi.org/10.1002/bjs.5353

    Article  CAS  PubMed  Google Scholar 

  29. 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. https://doi.org/10.1007/s10120-008-0481-8

    Article  PubMed  Google Scholar 

  30. Kim SG, Lee YJ, Ha WS, Jung EJ, Ju YT, Jeong CY, Hong SC, Choi SK, Park ST, Bae K (2008) LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer? J Laparoendosc Adv Surg Tech A 18:572–578. https://doi.org/10.1089/lap.2007.0106

    Article  PubMed  Google Scholar 

  31. Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, Chin HM, Hur H (2008) Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: Prospective, multicenter study. J Gastrointest Surg 12:1015–1021. https://doi.org/10.1007/s11605-008-0484-0

    Article  PubMed  Google Scholar 

  32. Nagai E, Ohuchida K, Nakata K, Miyasaka Y, Maeyama R, Toma H, Shimizu S, Tanaka M (2013) Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers. Surgery 153:732–738. https://doi.org/10.1016/j.surg.2012.10.012

    Article  PubMed  Google Scholar 

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Correspondence to Jin-Jo Kim.

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Drs. Han-Kwang Yang, Woo Jin Hyung, Sang-Uk Han, Young-Jun Lee, Joong-Min Park, Gyu Seok Cho, Oh Kyoung Kwon, Seong-Ho Kong, Hyoung-Il Kim, Hyuk-Joon Lee, Wook Kim, Seung Wan Ryu, Sung-Ho Jin, Sung Jin Oh, Keun Won Ryu, Min-Chan Kim, Hye Seong Ahn, Young Kyu Park, Yong Ho Kim, Sun-Hwi Hwang, Jong Won Kim, and Jin-Jo Kim have no conflicts of interest or financial ties to disclose.

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Yang, HK., Hyung, W.J., Han, SU. et al. Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage I proximal gastric cancer: results of a single-arm multicenter phase II clinical trial in Korea, KLASS 03. Surg Endosc 35, 1156–1163 (2021). https://doi.org/10.1007/s00464-020-07480-0

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