Skip to main content
SpringerLink
Log in

A novel method of anvil placement of circular stapler for esophagojejunostomy in laparoscopic total gastrectomy for gastric cancer: results of consecutive 200 cases

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic total gastrectomy for gastric cancer is still a demanding operation because of technical difficulties, especially of intracorporeal esophago-jejunal anastomosis.

Methods

We introduced a newly designed method of anvil placement of circular stapling devices (CS) for laparoscopic esophagojejunostomy (EJS). A small incision was made on the anterior wall of the stomach, from which the anvil was inserted into the stomach and proceeded to the thoracic esophagus. Then, the abdominal esophagus was transected by a linear stapler, and the anvil into the esophagus was drawn back to the esophageal stump by pulling out the cotton tape pre-attached to the anvil. Intracorporeal EJS by Roux-en-Y reconstruction was performed by CS inserted into the abdominal cavity from the umbilical wound.

Results

A total of consecutive 200 gastric cancer patients underwent laparoscopic total gastrectomy using this method. There was no operative mortality. Anastomotic complications occurred in 12 cases (6.0%): 9 cases of stenosis (4.5%) and 3 cases of bleedings (1.5%). Anastomotic leakage was not observed. As for non-anastomotic complications, there occurred 2 pulmonary complications (1.0%), 3 pancreatic leakages (1.5%), and 8 bowel obstructions due to internal hernia (4.0%). With a median follow-up period of 47.1 months, 5-year overall survival for assessable patients (n = 193) was 60.3% (95% CI 52.6–67.2). The total rate of peritoneal recurrence was 9.8%.

Conclusion

Our new method of anvil placement for laparoscopic EJS with CS is safe and feasible with favorable survival outcomes. It eliminates the need for suturing, and will promote the clinical application of laparoscopic total gastrectomy for gastric cancer.

Clinical trials

UMIN000046119.

Graphical abstract

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. 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(44):8114–8132

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kawaguchi Y, Shiraishi K, Akaike H, Ichikawa D (2018) Current status of laparoscopic total gastrectomy. Ann Gastroenterol Surg 3(1):14–23

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nakamura K, Katai H, Mizusawa J, Yoshikawa T, Ando M, Terashima M, Ito S, Takagi M, Takagane A, Ninomiya M, Fukushima N, Sasako M (2013) A phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer (JCOG0912). Jpn J Clin Oncol 43(3):324–327

    Article  PubMed  Google Scholar 

  4. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, random- ized trial (KLASS Trial). Ann Surg 251(3):417–420

    Article  PubMed  Google Scholar 

  5. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34(12):1350–1357

    Article  PubMed  Google Scholar 

  6. Hur H, Lee HY, Lee HJ, Kim MC, Hyung WJ, Park YK, Kim W, Han SK (2015) Efficacy of laparoscopic subtotal gas- trectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized con- trolled clinical trial. BMC Cancer 15:355–362

    Article  PubMed  PubMed Central  Google Scholar 

  7. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy- assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741

    Article  PubMed  Google Scholar 

  8. Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N, Kinoshita T, Iwasaki Y, Misawa K, Takiguchi N, Kaji M, Okitsu H, Yoshikawa T, Terashima M, Stomach Cancer Study Group of Japan Clinical Oncology Group (2019) Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan clinical oncology group study JCOG1401. Gastric Cancer 22(5):999–1008

    Article  CAS  PubMed  Google Scholar 

  9. Liu F, Huang C, Xu Z, Su X, Zhao G, Ye J, Du X, Huang H, Hu J, Li G, Yu P, Li Y, Suo J, Zhao N, Zhang W, Li H, He H, Sun Y, Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group (2020) Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage I gastric cancer: the CLASS02 multicenter randomized clinical trial. JAMA Oncol 6(10):1590–1597

    Article  PubMed  Google Scholar 

  10. 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 M-C, Ahn H-S, Park YK, Kim YH, Hwang SH, Kim JW, Cho GS (2019) 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(1):214–222

    Article  CAS  PubMed  Google Scholar 

  11. Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, Tsujitani S, Ono H, Tanabe S, Fukagawa T, Nunobe S, Kakeji Y, Nashimoto A, Registration Committee of the Japanese Gastric Cancer Association (2018) Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese gastric cancer association (2001–2007). Gastric Cancer 21(1):144–154

    Article  PubMed  Google Scholar 

  12. Shiroshita H, Inomata M, Bandoh T, Uchida H, Akira S, Hashizume M, Yamaguchi S, Eguchi S, Wada N, Takiguchi S, Ieiri S, Endo S, Iwazaki M, Tamaki Y, Tabata M, Kanayama H, Mimata H, Hasegawa T, Onishi K, Yanaga K, Morikawa T, Terachi T, Matsumoto S, Yamashita Y, Kitano S, Watanabe M (2019) Endoscopic surgery in Japan: the 13th national survey (2014–2015) by the Japan society for endoscopic surgery. Asian J Endosc Surg 12(1):7–18

    Article  PubMed  Google Scholar 

  13. 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(2):102–112

    Article  PubMed  Google Scholar 

  14. Omori T, Moon JH, Yamamoto K, Yanagimoto Y, Sugimura K, Miyata H, Yano M, Sakon M (2017) A modified efficient purse-string stapling technique (mEST) that uses a new metal rod for intracorporeal esophagojejunostomy in laparoscopic total gastrectomy. Transl Gastroenterol Hepatol 2(7):61–68

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kim HH, Park YK, Uyama I (2012) Reconstruction for esophagojejunostomy. In: Kitano S, Yang H-K (eds) Laparoscopic gastrectomy for cancer: standard techniques and clinical evidences. Springer Japan, Tokyo, pp 111–118

    Chapter  Google Scholar 

  16. 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(29):8943–8951

    Article  PubMed  PubMed Central  Google Scholar 

  17. Murakami K, Obama K, Tsunoda S, Hisamori S, Nishigori T, Hida K, Kanaya S, Satoh S, Manaka D, Yamamoto M, Kadokawa Y, Itami A, Okabe H, Hata H, Tanaka E, Yamashita Y, Kondo M, Hosogi H, Hoshino N, Tanaka S, Sakai Y (2020) Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy. Surg Endosc 34(12):5265–5273

    Article  PubMed  Google Scholar 

  18. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

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

    Article  Google Scholar 

  20. Yoshikawa T, Hayashi T, Aoyama T, Cho H, Fujikawa H, Shirai J, Hasegawa S, Yamada T, Oshima T, Yukawa N, Rino Y, Masuda M, Ogata T, Tsuburaya A (2013) Laparoscopic esophagojejunostomy using the EndoStich and a circular stapler under a direct view created by the ENDOCAMELEON. Gastric Cancer 16(4):609–614

    Article  PubMed  Google Scholar 

  21. Tsuchida K, Saeki H, Yasukawa M, Toda S, Kamioka Y, Suematsu H, Numata K, Higuchi A, Matsukawa H, Rino Y, Masuda M (2019) Short-term outcomes of laparoscopic-assisted total gastrectomy using the endoscopic purse-string suture instrument ENDO-PSI. Gan To Kagaku Ryoho 46(13):2503–2505

    PubMed  Google Scholar 

  22. 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(2):218–226

    Article  PubMed  Google Scholar 

  23. 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(32):9656–9665

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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(9):4086–4091

    Article  PubMed  Google Scholar 

  25. Lee TG, Lee IS, Yook JH, Kim BS (2017) Totally laparoscopic total gastrectomy using the overlap method; early outcomes of 50 consecutive cases. Surg Endosc 31(8):3186–3190

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the patients and families who participated in this trial.

Funding

The authors have not disclosed any funding.

Author information

Authors and Affiliations

  1. Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan

    Dai Manaka, Sayuri Konishi, Kiyotaka Kawaguchi, Hideo An, Shinya Hamasu, Machi Yoneda, Masashi Fushitani, Takano Ota, Michina Morioka, Yusuke Okamura, Atsushi Ikeda, Naoya Sasaki & Ryuta Nishitai

Authors
  1. Dai Manaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sayuri Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyotaka Kawaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideo An
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinya Hamasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Machi Yoneda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Fushitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takano Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michina Morioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yusuke Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Atsushi Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Naoya Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ryuta Nishitai
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DM, SK, KK, HA, SH, and RN were involved in study design and data interpretation. DM, SK, KK, and HA were involved in the data analysis. All authors critically revised the report, commented on drafts of the manuscript, and approved the final report.

Corresponding author

Correspondence to Dai Manaka.

Ethics declarations

Disclosures

Drs. Dai Manaka, Sayuri Konishi, Hideo An, Kiyotaka Kawaguchi, Shinya Hamasu, Machi Yoneda, Masashi Fushitani, Takano Ota, Michina Morioka, Yusuke Okamura, Atsushi Ikeda, Naoya Sasaki, and Ryuta Nishitai have no conflict of interest or financial ties to disclose.

Research involving human and animal participants

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or substitute for it was obtained from all patients for being included in the study.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manaka, D., Konishi, S., Kawaguchi, K. et al. A novel method of anvil placement of circular stapler for esophagojejunostomy in laparoscopic total gastrectomy for gastric cancer: results of consecutive 200 cases. Surg Endosc 37, 1021–1030 (2023). https://doi.org/10.1007/s00464-022-09566-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09566-3

Keywords

Search

Navigation