Digestive tract reconstruction of laparoscopic total gastrectomy for gastric cancer: a comparison of the intracorporeal overlap, intracorporeal hand-sewn anastomosis, and extracorporeal anastomosis

Abstract

Background: The application of esophagojejunostomy has certain difficulties in totally laparoscopic total gastrectomy (TLTG). This is due to the higher requirement for surgical techniques and the lack of any unified standards. This study aim to explore the practicability and safety of intracorporeal overlap and intracorporeal hand-sewn anastomosis compared with extracorporeal anastomosis. Methods:The clinical pathological data of 56 patients who underwent TLTG from March 2016 to Decemeber 2020 in the Harbin Medical University Cancer Hospital were retrospectively analyzed. According to the method of anastomosis, the patients were divided into the overlap (n=36) and the hand-sewn anastomosis (n=20). Patients who receive laparoscopic-assisted total gastrectomy (LATG; n=74) formed the control group.The basic clinical data, and intraoperative and postoperative results of the patients were assessed.Results: Compared with the control group, the overlap anastomosis and hand-sewn anastomosis groups showed no significant differences in clinicopathological data and short-term postoperative recovery. There were no significant differences between the overlap and the control group in operation time nor anastomosis time. However, the anastomosis time of the hand-sewn anastomosis group was significantly prolonged compared to the control group (53.20±14.14 vs. 43.01±12.53 minutes, P=0.002). Compared with the control group, the operation cost was significantly higher in the overlap group (CNY 81,300±6,100 vs. CNY 76,600±6,800, P=0.001), but significantly lower in the hand-sewn anastomosis group (CNY 71,900±1,700 vs. CNY 76,600±6,800, P=0.003). Early postoperative complications occurred in 5 cases (13.9%) in the overlap group, 3 cases (15.0%) in the hand-sewn anastomosis group, and 11 cases (14.9%) in the control group. There were 3 cases (8.3%) of postoperative anastomotic-related complications in the overlap group. No anastomotic-related complications were observed in the hand-sewn anastomosis group. Conclusions:The overlap anastomosis and hand-sewn anastomosis are practical and safe. Furthermore, the overlap anastomosis may be more suitable for patients with lower cardia and fundic lesions. The hand-sewn method has a wider range of indications pending advanced surgical skills, and is an effective supplementary technique for instrument anastomosis.

Totally laparoscopic total gastrectomy with linear anastomosis versus laparoscopic-assisted total gastrectomy in gastric cancer：a single-center experience with meta-analysis

“…con rmed the safety and feasibility of TLTG (overlap reconstruction) in advanced Siewert III esophagogastric junction cancer and the upper and middle third of gastric cancer by a prospective, single-center, single-blind, two-arm randomized controlled trial [22]. However, few comparative studies between TLTG with linear stapler and LATG have been reported.…”

“…strategy identi ed 165 articles mentioned TLTG and LATG for gastric cancer from the three major electronic databases. After reviewing the titles and abstracts, we selected 10 articles based on the inclusion and exclusion criteria and the characteristics were listed in Table S6 [15,[17][18][19][20][21][22][23][24][25].…”

Comparing intracorporeal mechanical anastomosis vs. hand-sewn esophagojejunostomy after total laparoscopic gastrectomy for esophagogastric junction cancer: a single-center study

“…Compared with mechanical anastomosis, hand-sewn anastomosis has fewer clinical applications and higher requirements for good suture techniques. Nevertheless, the advantages associated with this method include low-cost operation in a narrow space, a good surgical field of view to avoid excessive traction, and easy obtainment of the pathology of the esophageal cutting edge before anastomosis [6]. Hand-sewn anastomosis has been reported to be a safe and feasible procedure [6][7][8][9][10], but the clinical research remains insufficient.…”

“…Nevertheless, the advantages associated with this method include low-cost operation in a narrow space, a good surgical field of view to avoid excessive traction, and easy obtainment of the pathology of the esophageal cutting edge before anastomosis [6]. Hand-sewn anastomosis has been reported to be a safe and feasible procedure [6][7][8][9][10], but the clinical research remains insufficient. Although many laparoscopic suture methods are available, more simple, reliable, and repeatable anastomotic methods still need to be explored.…”

Application value of continuous seromuscular layer sutures in the reinforcement of esophagojejunostomy in total gastrectomy for gastric cancer: a retrospective comparative cohort study

“…Even with a 3-row stapler, there may be bleeding from the anastomotic stoma. Further, the incidence of anastomotic stenosis has been reported to be correlated with the use of circular staplers ( 17 , 18 ).…”