Abstract
Background
Laparoscopic total gastrectomy (LTG) is used for early gastric cancer (EGC) in the upper stomach. However, the incidences of postoperative anastomotic complications such as leakage and stricture remain high. This study investigated whether using a single-stapling technique (SST) instead of a hemi-double-stapling technique (HDST) for intracorporeal circular-stapled esophagojejunostomy could reduce anastomotic complications after LTG.
Methods
This retrospective study included 136 patients with EGC treated by LTG with intracorporeal circular-stapled esophagojejunostomy. Originally, HDST was used for esophagojejunostomy in 71 patients (original group). Thereafter, the esophagojejunostomy procedure was modified, and SST was used in a further 65 patients (modified group). The impact of the anastomotic procedure (SST or HDST) on anastomotic complications after LTG was determined by uni- and multivariate analyses.
Results
The incidence of anastomotic complications was significantly lower in the modified group (7.7 %) than in the original group (22.5 %; P = 0.017). The frequency of anastomotic leakage was lower in the modified group (3.1 %) than in the original group (9.9 %), although the difference was not statistically significant. Meanwhile, the frequency of anastomotic stricture was significantly less common in the modified group (6.2 %) than in the original group (18.3 %; P = 0.032). Multivariate analysis showed that anastomotic procedure with SST was significantly associated with a lower rate of postoperative anastomotic complications (odds ratio [OR], 0.217; 95 % confidence interval [CI], 0.063–0.631; P = 0.004), as was the operation time (OR, 0.237; 95 % CI 0.082–0.667; P = 0.007).
Conclusions
The use of SST for intracorporeal circular-stapled esophagojejunostomy could reduce anastomotic complications after LTG.
Similar content being viewed by others
References
Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13:238–44.
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245:68–72.
Fukunaga T, Hiki N, Kubota T, Nunobe S, Tokunaga M, Nohara K, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:2676–82.
Hiki N. Present features and future vision of laparoscopy-assisted total gastrectomy (LATG). Gastric Cancer. 2013;16:460–1.
Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK. Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc. 2012;26:3418–25.
Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, 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.
Nunobe S, Hiki N, Tanimura S, Kubota T, Kumagai K, Sano T, et al. Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg. 2011;15:1520–5.
Shim JH, Oh SI, Yoo HM, Jeon HM, Park CH, Song KY. Short-term outcomes of laparoscopic versus open total gastrectomy: a matched-cohort study. Am J Surg. 2013;206:346–51.
Kosuga T, Hiki N, Nunobe S, Noma H, Honda M, Tanimura S, et al. Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol. 2014;21:2028–35.
Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, et al. Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc. 2013;27:3683–9.
Fukagawa T, Gotoda T, Oda I, Deguchi Y, Saka M, Morita S, et al. Stenosis of esophagojejuno anastomosis after gastric surgery. World J Surg. 2010;34:1859–63.
Japanese Classification of Gastric Carcinoma, 3rd English edition. Gastric Cancer. 2011;14:101–12.
Japanese Gastric Cancer Treatment Guidelines 2010 (version 3). Gastric Cancer. 2011;14:113–23.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, et al. Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer. 2007;10:181–6.
Conflict of interest
There are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Kosuga, T., Hiki, N., Nunobe, S. et al. Does the Single-Stapling Technique for Circular-Stapled Esophagojejunostomy Reduce Anastomotic Complications After Laparoscopic Total Gastrectomy?. Ann Surg Oncol 22, 3606–3612 (2015). https://doi.org/10.1245/s10434-015-4417-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-015-4417-3