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Jejunal Mesentery Preservation Reduces Leakage at Esophagojejunostomy After Minimally Invasive Total Gastrectomy for Gastric Cancer: a Propensity Score–Matched Cohort Study

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Journal of Gastrointestinal Surgery

Abstract 

Purpose

The mesentery of the jejunum (MJ) of the Roux limb is conventionally divided when Roux-en-Y reconstruction is performed after total gastrectomy for gastric cancer (GC). However, the impact of dividing or preserving the MJ on anastomotic leakage (AL) at the esophagojejunostomy (EJS) site after minimally invasive total gastrectomy for GC is unclear.

Methods

This retrospective cohort study enrolled 226 patients with GC who underwent EJS after laparoscopic or robotic total gastrectomy, including preservation of the MJ (n = 87) and division of the MJ (n = 137). The prevalence of anastomotic complications at the EJS and short-term outcomes were compared between groups using propensity score (PS) matching.

Results

After PS matching, 69 patients were selected for the preserving and dividing MJ groups. There were no significant intergroup differences in patient backgrounds, including oncological stage, body mass index, and gender ratio. After PS matching, overall and severe complications after surgery were compared between the preserving and dividing MJ groups (21.7% vs. 27.5%, p = 0.554 and 8.7% vs. 13.8%, p = 0.137, respectively). However, the rate of AL at the EJS was significantly lower in the preserving than that in the dividing MJ group (1.4% vs. 13.0%, p = 0.017). In addition, the median postoperative hospital stay was significantly shorter in the preserving than that in the dividing MJ group (13.0 days vs. 16.0 days, p = 0.005).

Conclusions

Preserving the MJ significantly reduced AL at the EJS after minimally invasive total gastrectomy for GC.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka City General Hospital, 1-4-3 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan

    Naoshi Kubo, Katsunobu Sakurai, Yutaka Tamamori, Tsuyoshi Hasegawa, Shuhei Kushiyama, Kenji Kuroda, Akihiro Murata, Takafumi Nishii, Akiko Tachimori, Sadatoshi Shimizu, Toru Inoue, Kiyoshi Maeda & Yukio Nishiguchi

  2. Department of Hepatobiliary Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan

    Akihiro Murata, Shintaro Kodai, Sadatoshi Shimizu & Akishige Kanazawa

  3. Department of Gastroenterological Surgery, Osaka Metropolitan University, Osaka, Japan

    Kiyoshi Maeda

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Kubo, N., Sakurai, K., Tamamori, Y. et al. Jejunal Mesentery Preservation Reduces Leakage at Esophagojejunostomy After Minimally Invasive Total Gastrectomy for Gastric Cancer: a Propensity Score–Matched Cohort Study. J Gastrointest Surg 26, 2460–2469 (2022). https://doi.org/10.1007/s11605-022-05494-8

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