Comparison of Intracorporeal Trapezoidal-shaped Gastroduodenostomy and Delta-shaped Anastomosis After Laparoscopic Distal Gastrectomy for Gastric Cancer: A Single-center Retrospective Study

Abstract

Background: Laparoscopic/robotic distal gastrectomy (LDG/RDG) as a treatment for early gastric cancer has become increasingly and widely accepted for its minimal invasiveness and proportionate outcomes. Over the years, in addition to the LDG/RDG technique and the lymphadenectomy and gastrectomy procedures, various reconstruction methods have been developed and further improved upon. In particular, the number of minimally invasive intracorporeal anastomosis reconstruction techniques has been increasing. Materials and Methods: The medical records of 445 patients with gastric cancer who underwent reconstruction following LDG/RDG via either trapezoidal-shaped gastroduodenostomy (TAPESTRY; n=126) or delta-shaped anastomosis (DSA; n=319) at our hospital between April 2012 and May 2021 were retrospectively reviewed. Short-term surgical outcomes, including the operation time, blood loss, length of hospital stay, and complications, were compared between the 2 groups. Anastomosis-related complications, namely leakage, bleeding, stricture, and delayed gastric emptying, were monitored and graded using the Clavien-Dindo classification. Results: All operations were either performed or supervised by qualified surgeons. Patients’ characteristics in the TAPESTRY group and the DSA group were biased in terms of the surgical approach, but they were well-balanced after propensity score matching. Overall anastomosis-related complications (Clavien-Dindo grade II or above) within 30 days after surgery in the TAPESTRY group were comparable with those in the DSA group, either all patients (1.5% vs. 5.0%, P=0.115) or after propensity score–matching analysis (2.1% vs. 6.5%, P=0.134). There were no records of reoperation or mortality during hospitalization in either group. Conclusions: TAPESTRY was performed safely, with a low rate of anastomosis-related complications. These findings suggest that trapezoidal-shaped gastroduodenostomy could be a feasible option for reconstruction in patients undergoing LDG/RDG.

Intracorporeal linear‑stapled gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: Consideration of the intraoperative management of the duodenal wall between the transecting staple line and anastomotic staple line (Review)

“…Iwasaki et al ( 24 ) indicated that the twisting of the duodenal bulb at the posteroanterior transection is technically demanding. In DSG, to obtain an adequate anastomotic area for the purpose of preventing anastomotic stenosis, the unsuccessful posteroanterior transection of the duodenal bulb due to its incomplete twisting may lead to extensive dissection of the supraduodenal vessels, that is, dissection of not only the cranial but also the caudal supraduodenal vessels ( 24 ). Similarly, when the duodenal bulb diameter is relatively short, extensive dissection of the supraduodenal vessels can be performed to obtain an adequate anastomotic area ( 26 ).…”

“…We hypothesized that although the blood supply via the remnant cranial supraduodenal vessels is blocked by the anastomotic linear staple, the blood supply of this area in the DSG is assumed to be retained via the caudal supraduodenal vessels because the caudal and cranial supraduodenal vessels anastomosed at the anterior wall, that is, at the antimesenteric side (4,5). Some authors have expressed concern that an insufficient supply of blood to the duodenal wall between the transecting staple line and anastomotic staple line in DSG could be caused by unsuccessful transection of the duodenal bulb in a posteroanterior direction and the extensive dissection of supraduodenal vessels (11,17,(21)(22)(23)(24)(25). Iwasaki et al (24) indicated that the twisting of the duodenal bulb at the posteroanterior transection is technically demanding.…”

“…Some authors have expressed concern that an insufficient supply of blood to the duodenal wall between the transecting staple line and anastomotic staple line in DSG could be caused by unsuccessful transection of the duodenal bulb in a posteroanterior direction and the extensive dissection of supraduodenal vessels (11,17,(21)(22)(23)(24)(25). Iwasaki et al (24) indicated that the twisting of the duodenal bulb at the posteroanterior transection is technically demanding. In DSG, to obtain an adequate anastomotic area for the purpose of preventing anastomotic stenosis, the unsuccessful posteroanterior transection of the duodenal bulb due to its incomplete twisting may lead to extensive dissection of the supraduodenal vessels, that is, dissection of not only the cranial but also the caudal supraduodenal vessels (24).…”