Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy

Murakami, Katsuhiro; Obama, Kazutaka; Tsunoda, Shigeru; Hisamori, Shigeo; Nishigori, Tatsuto; Hida, Koya; Kanaya, Shigehiko; Satoh, Seiji; Manaka, Dai; Yamamoto, Masafumi; Kadokawa, Yoshio; Itami, Atsushi; Okabe, Hiroshi; Hata, Hiroyuki; Tanaka, Eiji; Yamashita, Yoshito; Kondo, Masato; Hosogi, Hisahiro; Hoshino, Nobuaki; Tanaka, Shiro; Sakai, Yoshiharu

doi:10.1007/s00464-019-07313-9

Cited by 25 publications

(22 citation statements)

References 45 publications

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“…IEJ-related complications are an important topic in terms of using digestive reconstruction methods in TLTG. Previous studies have revealed that the rate of postoperative IEJ-related complications ranged from 0% to 11.7% [27][28][29]. The majority of the previous comparisons of IEJ-related complications between LS and CS approaches involved retrospective studies with small sample sizes; thus, the results are inconsistent and even contradictory [5,[30][31][32].…”

Section: Discussionmentioning

confidence: 99%

“…Among these studies, some revealed no difference in the E-J-related complication rate between the different methods. However, Murakami et al conducted a multicenter retrospective comparative study on LS and CS following TLTG, and reported that the incidence of anastomotic stenosis in the LS group was significantly lower than that in the CS group (1.5% vs. 7.1%, p = 0.011), and no postoperative anastomotic bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123) [28]. In agreement with previous studies, our outcomes did not show any differences in the rate of overall complications and E-J-related complications between the groups.…”

Section: Discussionmentioning

confidence: 99%

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Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

Qiu¹,

Zheng²,

Liang³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: With the development of minimally invasive surgery in recent years, totally laparoscopic total gastrectomy (TLTG) has attracted more attention.Aim: To introduce the more comprehensive "enjoyable space" approach coupled with the self-pulling and latter transaction (SPLT) reconstruction technique to perform TLTG and investigate its safety and feasibility. Material and methods: Ninety-seven patients with primary upper gastric cancer underwent laparoscopic radical total gastrectomy between January 2020 and December 2020. Among these patients, 46 underwent laparoscopic-assisted total gastrectomy (LATG), and 51 underwent TLTG. We compared the clinicopathological characteristics, surgical outcomes and postoperative complications between the two groups. Results: There were no significant differences in the clinicopathological characteristics between the two groups (p > 0.05). However, the TLTG group had a slightly lower mean operative time and mean blood loss than the LATG group (p < 0.05 each). Although there were similarities in the mean times to first flatus, liquid diet, and soft diet, the duration of hospital stay was significantly reduced in the TLTG group (p < 0.05). No significant differences in overall complications and E-J-related complications were found between the two groups (15.2% vs. 25.4%, p > 0.05). Conclusions: TLTG is a safe and feasible procedure for treating upper gastric cancer. The enjoyable space approach in conjunction with SPLT reconstruction is an appropriate comprehensive technique with several advantages over LATG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

Qiu¹,

Zheng²,

Liang³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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“…Anastomotic stenosis is a common complication in esophagojejunal anastomosis, especially when using a circular stapler. 24 In our modified π-shaped anastomosis, a 60-mm linear stapler was used for both the anastomosis and common entry hole closure, as in the traditional π-shaped anastomosis. 7 This procedure can maximally prevent stenosis; indeed, we found no stenosis in the postoperative radiographic examination of our study.…”

Section: Discussionmentioning

confidence: 99%

Modified π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy: a report of 40 consecutive cases from a single center

Xing

Gao

et al. 2022

J Int Med Res

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Objective Intracorporeal esophagojejunostomy remains a challenging technique in totally laparoscopic total gastrectomy (TLTG) because of the lack of an established standard anastomosis method. However, π-shaped esophagojejunostomy in TLTG is reportedly safe and feasible. Therefore, we evaluated the short-term surgical outcomes of our modified π-shaped esophagojejunostomy in TLTG. Methods This study involved patients without neoadjuvant therapy diagnosed with gastric cancer who underwent TLTG by the same surgeon with modified π-shaped esophagojejunostomy from April 2018 to October 2019. Clinicopathologic data were collected and retrospectively analyzed. Results Forty patients diagnosed with gastric cancer were included. The mean operative time and estimated blood loss were 264.6 ± 56.9 minutes and 68.5 ± 53.3 mL, respectively. Postoperative flatus occurred at 4.6 ± 1.7 days. The mean time to resumption of diet was 7.4 ± 1.7 days postoperatively. One patient was diagnosed with anastomotic leakage and managed with conservative therapy. Pleural effusion was the most common complication, occurring in four (10%) patients. One patient developed intra-abdominal bleeding that required reoperation. Other complications were atrial fibrillation and wound infection. No mortality occurred during the 6-month follow-up. Conclusions Modified π-shaped esophagojejunostomy is safe and feasible for intracorporeal anastomosis in TLTG and showed favorable surgical outcomes in this study.

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“…We applied linear stapling for this anastomosis making the procedure entirely robotic. According to literature, anastomotic strictures may be less frequent using the linear stapler [ 12 ]. The linear anastomosis, however, extends several centimeters up the esophagus contrary to the circular stapled anastomosis located at or near the the end of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Early experience with total robotic D2 gastrectomy in a low incidence region: surgical perspectives

et al. 2022

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Background Few European centers have reported on robotic gastrectomy for malignancy. We report our early experience with curative-intent total robotic gastrectomy. Materials and methods The Intuitive Surgery Da Vinci Surgical System Xi 4 armed robot was used. Routine D2 lymphadenectomy was applied. Results Some 27 patients with adenocarcinoma (n = 18), hereditary cancer susceptibility (n = 8) and premalignancy (n = 1) were allocated to robotic gastrectomy, three were excluded due to inoperability during surgery. Median (range) age was 66 (18–87) years, 14 (58.3%) were females and body mass index was 25.5 (22.1–33.5) kg/m2. Total gastrectomy was performed in 19 (79.2%) and subtotal in five (20.8%) patients. One (4.2%) procedure was converted to laparotomy. Procedural time was 273 (195–427) minutes. Three (12.5%) patients were reoperated within 30 days, one (4.2%) died. Serious complications (Clavien Dindo IIIb or more) occurred in three (12.5%) patients. Postoperative hospital stay was 10 (6–43) days. Fourteen of 16 (87.5%) patients with adenocarcinoma/premalignancy received radical resections. The median number of harvested lymph nodes was 20 (11–34). Eleven (73.3%) patients with adenocarcinoma had T3/T4 tumors and 6 (40%) had TNM stage III or more. Conclusion Total robotic D2 gastrectomy appears feasible and safe during early introduction in a low incidence region.

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Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy

Cited by 25 publications

References 45 publications

Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

Modified π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy: a report of 40 consecutive cases from a single center

Early experience with total robotic D2 gastrectomy in a low incidence region: surgical perspectives

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