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Annals of Surgical Oncology

, Volume 20, Issue 9, pp 2975–2983 | Cite as

Esophagojejunal Reconstruction After Total Gastrectomy for Gastric Cancer Using a Transorally Inserted Anvil Delivery System

  • J. LaFemina
  • E. F. Viñuela
  • M. A. Schattner
  • H. Gerdes
  • V. E. StrongEmail author
Gastrointestinal Oncology

Abstract

Introduction

Total gastrectomy (TG) is commonly performed for the treatment of patients with gastric cancer. However, reconstruction of the esophagojejunal (EJ) anastomosis can be technically demanding, with reported anastomotic leak rates in the Western world still approaching 10–15 %. We report our experience using the transoral anvil delivery system (OrVil™) for creation of the EJ anastomosis after TG.

Methods

From 2007 to 2011, 48 consecutive patients with gastric cancer underwent open (n = 31) or laparoscopic (n = 17) TG. EJ reconstruction was performed with the transoral anvil deliver system (OrVil™) in an end-to-side fashion. Demographic, clinic, and perioperative data were obtained from a prospectively maintained database.

Results

Of the 48 patients, 83 % were male. Median age at resection was 64 years. Median body mass index was 27.1 kg/m2. Seventy-nine percent (n = 38) of patients had at least one comorbidity. Fifteen patients (31 %) had at least one perioperative complication. There was one perioperative death (2 %) following a duodenal stump leak. There were four EJ leaks (8 %) and two EJ stenoses (independent of leak; 4 %). There was one EJ leak (6 %) and one EJ stenosis (6 %) following a case that was first attempted laparoscopically. There were no deaths as a consequence of an EJ leak.

Conclusions

The use of the transoral anvil delivery system during EJ reconstruction is a safe and effective option for reconstruction after open or laparoscopic TG with acceptable mortality and morbidity. The anastomotic leak rate appears to be comparable to that of other techniques.

Keywords

Gastric Cancer Total Gastrectomy Median Body Mass Index Laparoscopic Total Gastrectomy Anastomotic Leak Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Barbour AP, Rizk NP, Gonen M, et al. Lymphadenectomy for adenocarcinoma of the gastroesophageal junction (GEJ): impact of adequate staging on outcome. Ann Surg Oncol. 2007;14:306–16.PubMedCrossRefGoogle Scholar
  2. 2.
    Pacelli F, Papa V, Rosa F, et al. Four hundred consecutive total gastrectomies for gastric cancer: a single-institution experience. Arch Surg. 2008;143:769–75; discussion 775.PubMedCrossRefGoogle Scholar
  3. 3.
    Siewert JR, Bottcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998;228:449–61.PubMedCrossRefGoogle Scholar
  4. 4.
    Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg. 2009;13:239–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Sierzega M, Kolodziejczyk P, Kulig J. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97:1035–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Huscher CG, Mingoli A, Sgarzini G, et al. Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg. 2007;194:839–44; discussion 844.PubMedCrossRefGoogle Scholar
  7. 7.
    Okabe H, Obama K, Tanaka E, et al. Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc. 2009;23:2167–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Ziqiang W, ZhiMin C, Jun C, et al. A modified method of laparoscopic side-to-side esophagojejunal anastomosis: report of 14 cases. Surg Endosc. 2008;22:2091–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Shinohara T, Kanaya S, Taniguchi K, et al. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg. 2009;144:1138–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251:640–6.PubMedCrossRefGoogle Scholar
  11. 11.
    O’Riordain DS, Buckley DJ, Waldron DJ, Kirwan WO. Purse-string suture for stapled oesophagogastric anastomosis: hand-sewn versus automatic. Br J Surg. 1993;80:734–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010;251:417–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Vinuela EF, Gonen M, Brennan MF, et al. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.PubMedCrossRefGoogle Scholar
  14. 14.
    Wainess RM, Dimick JB, Upchurch GR Jr, et al. Epidemiology of surgically treated gastric cancer in the United States, 1988–2000. J Gastrointest Surg. 2003;7:879–83.PubMedGoogle Scholar
  15. 15.
    Lee JH, Paik YH, Lee JS, et al. Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol. 2007;14:1288–94.PubMedCrossRefGoogle Scholar
  16. 16.
    Ojima T, Iwahashi M, Nakamori M, et al. Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center. Arch Surg. 2009;144:351–8; discussion 358.PubMedCrossRefGoogle Scholar
  17. 17.
    Tokunaga M, Hiki N, Fukunaga T, et al. Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg. 2009;96:496–500.PubMedCrossRefGoogle Scholar
  18. 18.
    Kodera Y, Sasako M, Yamamoto S, et al. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg. 2005;92:1103–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ueda J, Ichimiya H, Okido M, Kato M. The impact of visceral fat accumulation on laparoscopy-assisted distal gastrectomy for early gastric cancer. J Laparoendosc Adv Surg Tech A. 2009;19:157–62.PubMedCrossRefGoogle Scholar
  20. 20.
    Hiki N, Fukunaga T, Yamaguchi T, et al. Increased fat content and body shape have little effect on the accuracy of lymph node retrieval and blood loss in laparoscopic distal gastrectomy for gastric cancer. J Gastrointest Surg. 2009;13:626–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Makino H, Kunisaki C, Izumisawa Y, et al. Effect of obesity on laparoscopy-assisted distal gastrectomy compared with open distal gastrectomy for gastric cancer. J Surg Oncol. 2010;102:141–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Yasuda K, Sonoda K, Shiroshita H, et al. Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly. Br J Surg. 2004;91:1061–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Hwang SH, Park do J, Jee YS, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg. 2009;208:186–92.Google Scholar
  24. 24.
    Lee HJ, Kim HH, Kim MC, et al. The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer. Surg Endosc. 2009;23:2473–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith DL, Elting LS, Learn PA, et al. Factors influencing the volume-outcome relationship in gastrectomies: a population-based study. Ann Surg Oncol. 2007;14:1846–52.PubMedCrossRefGoogle Scholar
  26. 26.
    Kunisaki C, Makino H, Takagawa R, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc. 2009;23:377–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Isozaki H, Okajima K, Ichinona T, et al. Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer. Hepatogastroenterology. 1997;44:1509–12.PubMedGoogle Scholar
  28. 28.
    Pol B, LeTreut YP, Hardwigsen J, et al. Mechanically stapled esophagojejunostomy. Results of a prospective series of 176 cases. Hepatogastroenterology. 1997;44:458–66.PubMedGoogle Scholar
  29. 29.
    Takeyoshi I, Ohwada S, Ogawa T, et al. Esophageal anastomosis following gastrectomy for gastric cancer: comparison of hand-sewn and stapling technique. Hepatogastroenterology. 2000;47:1026–9.PubMedGoogle Scholar
  30. 30.
    Doglietto GB, Papa V, Tortorelli AP, et al. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial. Arch Surg. 2004;139:1309–13; discussion 1313.PubMedCrossRefGoogle Scholar
  31. 31.
    Lamb PJ, Griffin SM, Chandrashekar MV, et al. Prospective study of routine contrast radiology after total gastrectomy. Br J Surg. 2004;91:1015–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Pesko P, Bjelovic M, Stojakov D, Sabljak P. Modified stapling technique of esophagojejunal anastomosis. Dis Esophagus. 2002;15:303–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Sakuramoto S, Kikuchi S, Futawatari N, et al. Technique of esophagojejunostomy using transoral placement of the pretilted anvil head after laparoscopic gastrectomy for gastric cancer. Surgery. 2010;147:742–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Habu H, Kando F, Saito N, et al. Experience with EEA stapler for esophagojejunostomy. Int Surg. 1989;74:73–6.PubMedGoogle Scholar
  35. 35.
    Seufert RM, Schmidt-Matthiessen A, Beyer A. Total gastrectomy and oesophagojejunostomy: a prospective randomized trial of hand-sutured versus mechanical stapled anastomoses. Br J Surg. 1990;77:50–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Fujimoto S, Takahashi M, Endoh F, et al. Stapled or manual suturing in esophagojejunostomy after total gastrectomy: a comparison of outcome in 379 patients. Am J Surg. 1991;162:256–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Nomura S, Sasako M, Katai H, et al. Decreasing complication rates with stapled esophagojejunostomy following a learning curve. Gastric Cancer. 2000;3:97–101.PubMedCrossRefGoogle Scholar
  38. 38.
    Hyodo M, Hosoya Y, Hirashima Y, et al. Minimum leakage rate (0.5 %) of stapled esophagojejunostomy with sacrifice of a small part of the jejunum after total gastrectomy in 390 consecutive patients. Dig Surg. 2007;24:169–72.PubMedCrossRefGoogle Scholar
  39. 39.
    Bracale U, Marzano E, Nastro P, et al. Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc. 2010;24:2475–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg. 2010;211:e25–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Tsujimoto H, Uyama I, Yaguchi Y et al. Outcome of overlap anastomosis using a linear stapler after laparoscopic total and proximal gastrectomy. Langenbecks Arch Surg. 2012;397:833–40.PubMedCrossRefGoogle Scholar
  42. 42.
    Carboni F, Lepiane P, Santoro R, et al. Laparoscopic surgery for gastric cancer: preliminary experience. Gastric Cancer. 2005;8:75–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Dulucq JL, Wintringer P, Perissat J, et al. Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg. 2005;200:191–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Ibanez Aguirre FJ, Azagra JS, Erro Azcarate ML, et al. Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results. Rev Esp Enferm Dig. 2006;98:491–500.PubMedGoogle Scholar
  45. 45.
    Kim SG, Lee YJ, Ha WS, et al. LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer? J Laparoendosc Adv Surg Tech A. 2008;18:572–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Mochiki E, Toyomasu Y, Ogata K, et al. Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc. 2008;22:1997–2002.PubMedCrossRefGoogle Scholar
  47. 47.
    Topal B, Leys E, Ectors N, et al. Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc. 2008;22:980–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Usui S, Nagai K, Hiranuma S, et al. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer. 2008;11:233–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Allieta R, Nardi M Jr, Brachet-Contul R, et al. Laparoscopic gastrectomy for treatment of advanced gastric cancer: preliminary experience on 38 cases. Minerva Chir. 2009;64:445–56.PubMedGoogle Scholar
  50. 50.
    Jeong GA, Cho GS, Kim HH, et al. Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery. 2009;146:469–74.PubMedCrossRefGoogle Scholar
  51. 51.
    Lee SE, Ryu KW, Nam BH, et al. Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol. 2009;100:392–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Kinoshita T, Oshiro T, Ito K, et al. Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc. 2010;24:2908–12.PubMedCrossRefGoogle Scholar
  53. 53.
    Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc. 2009;23:2624–30.PubMedCrossRefGoogle Scholar
  54. 54.
    Kachikwu EL, Trisal V, Kim J, et al. Minimally invasive total gastrectomy for gastric cancer: A pilot series. J Gastrointest Surg. 2011;15:81–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc. 2011;25:1300–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Marangogi G, Villa F, Shamil E. et al. OrVil™-assisted anastomosis in laparoscopic upper gastrointestinal surgery: friend of the laparoscopic surgeon. Surg Endosc. 2012;26:811–7.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • J. LaFemina
    • 1
  • E. F. Viñuela
    • 1
  • M. A. Schattner
    • 2
  • H. Gerdes
    • 2
  • V. E. Strong
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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