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Safety and Efficacy of OGT-Assisted Overlap Oesophagojejunostomy Versus the Traditional Overlap Method in Laparoscopic Total Gastrectomy for Gastric/Gastroesophageal Junction (G/GEJ) Tumours

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Overlap guiding tube (OGT)-assisted overlap oesophagojejunostomy (EJS), which was first designed and reported by our team, has shown feasibility. However, its safety and efficiency have not yet been compared with the conventional overlap approach.

Methods

We retrospectively analysed the data of 155 gastric/gastroesophageal junction (G/GEJ) cancer patients who underwent laparoscopic total gastrectomy by conventional (conventional group, n = 83) or OGT-assisted (OGT group, n = 72) overlap methods at Nanfang Hospital. The anastomotic efficiency and surgical outcomes were compared between the two groups.

Results

The success rate of inserting an anvil fork into the oesophageal lumen at the first attempt in the OGT group was much higher than in the conventional group (86.7% vs. 97.2%, P = 0.019). Consistently, the duration of EJS (P < 0.001) in the OGT group was significantly shorter than that in the conventional group. Operatively, there was one case in which oesophageal pseudocanals developed; another case was converted to thoracoscopic surgery in the conventional group, but there were no such cases in the OGT group. In terms of postoperative recovery, the OGT group was superior to the conventional group. The incidence of postoperative complications (28.9% vs. 20.8%, P = 0.247) and the classification of complication severity (P = 0.450) were milder in the OGT group, although the difference was not statistically significant. Notably, the conventional group had four cases (4.8%) of oesophagojejunal anastomotic leakage (EJAL) and one case (1.2%) of anastomotic stenosis. In the OGT group, two patients (2.8%) developed EJAL, but none developed anastomotic stenosis or anastomotic bleeding. Neither group had any cases of unplanned secondary surgery or perioperative deaths.

Conclusions

The OGT-assisted method reduced the surgical difficulty of overlap EJS with good safety. This study provides new perspectives for optimizing EJS.

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Acknowledgement

This work was supported by grants from the Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer (2020B121201004) and the Clinical Research Program of Nanfang Hospital, Southern Medical University (2021CR001). Many thanks are extended to Dr Mengyao Li for drawing the outline of the OGT-assisted overlap method.

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Author notes

  1. Xinhua Chen, Tian Lin, Mingli Zhao and Jia Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China

    Xinhua Chen MD, Tian Lin MD, Mingli Zhao MD, Jia Yang MD, Huilin Huang MD, Liying Zhao MD, Hao Liu MD, PhD, Tao Chen MD, PhD, Hao Chen MD, FRCS, Yanfeng Hu MD, PhD, Guoxin Li MD, PhD, FRCS & Jiang Yu MD, PhD

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  1. Xinhua Chen MD
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Correspondence to Yanfeng Hu MD, PhD, Guoxin Li MD, PhD, FRCS or Jiang Yu MD, PhD.

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Ethics Statement

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 or a substitute for such consent was obtained from all patients for inclusion in the study.

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Chen, X., Lin, T., Zhao, M. et al. Safety and Efficacy of OGT-Assisted Overlap Oesophagojejunostomy Versus the Traditional Overlap Method in Laparoscopic Total Gastrectomy for Gastric/Gastroesophageal Junction (G/GEJ) Tumours. Ann Surg Oncol 30, 2729–2738 (2023). https://doi.org/10.1245/s10434-022-13031-9

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