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Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients.

Methods

A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil™) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded.

Results

Overall, DST was performed in 60 patients [total gastrectomy (81.7 %, n = 49/60), proximal gastrectomy (10.0 %, n = 6/60), and completion gastrectomy (8.3 %, n = 5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0 %), and 6 patients (10.0 %) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7 %, n = 31/60), laparoscopic (43.3 %, n = 26/60), or robotic (5.0 %, n = 3/60). Anastomotic leak occurred in 6.7 % (n = 4/60), while stricture independent of leak was identified in 19.0 % (n = 11/58) of patients. Complications occurred in 38.3 % (n = 23/60) of patients, of which 52 % were classified as Clavien-Dindo grades III–V complications.

Conclusion

In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.

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Funding Support

Dr. Chao’s efforts were supported by the National Cancer Institute of the National Institutes of Health under award number NIH 5K12CA001727-20. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There was no additional funding provided by any source.

Conflict of Interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Audrey H. Choi, Ann Falor & Byrne Lee

  2. Department of Surgery, Marshall University Edwards Comprehensive Cancer Center, Huntington, WV, USA

    Amanda Arrington

  3. Departments of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA

    Rebecca A. Nelson

  4. Departments of Anesthesia, City of Hope National Medical Center, Duarte, CA, USA

    Michael Lew

  5. Departments of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA

    Joseph Chao

  6. Division of Surgical Oncology, Department of Surgery, SUNY Stony Brook, New York, NY, USA

    Joseph Kim

Authors
  1. Audrey H. Choi
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  2. Amanda Arrington
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  3. Ann Falor
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  4. Rebecca A. Nelson
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  5. Michael Lew
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  6. Joseph Chao
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  7. Byrne Lee
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  8. Joseph Kim
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Corresponding authors

Correspondence to Byrne Lee or Joseph Kim.

Additional information

Byrne Lee and Joseph Kim are co-senior authors.

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Choi, A.H., Arrington, A., Falor, A. et al. Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer. J Gastrointest Surg 20, 688–692 (2016). https://doi.org/10.1007/s11605-016-3087-1

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  • DOI: https://doi.org/10.1007/s11605-016-3087-1

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