The safety of esophagojejunostomy via a transorally inserted-anvil method vs extracorporeal anastomosis using a circular stapler during total gastrectomy for Siewert type 2 adenocarcinoma of the esophagogastric junction

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Intracorporeal esophagojejunostomy via a transorally inserted-anvil method during laparoscopic total gastrectomy (LTG) for upper gastric cancer has been demonstrated to be feasible, but the use of this assessment exclusively for Siewert type 2 adenocarcinoma of the esophagogastric junction (AEG) has not been reported.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A total of 428 consecutive gastric-cancer patients who underwent LTG in Nanfang Hospital from January 2008 to December 2016 were reviewed. Among these patients, 98 were classified as Siewert type 2 AEG. The patients underwent intracorporeal esophagojejunostomy through either a transorally inserted-anvil method (n = 27) or extracorporeal anastomosis usinga circular stapler (n = 71). After generating propensity scores with covariates that were associated with developing anastomotic leakage, 26 patients who underwent esophagojejunostomy via the transorally inserted-anvil method (transoral group) were 1:1 matched with 26 patients who underwent the procedure via extracorporeal anastomosis using a circular stapler (extracorporeal group). The safety after 30 days post-operatively was compared between the two groups.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The transoral group and extracorporeal group were balanced regarding the baseline variables. The operative time, reconstruction duration, number of dissected lymph nodes, length of the proximal resection margins, estimated blood loss, intra-operative complication rate, and post-operative recovery course were not significantly different between the two groups. The mean anvil-insertion completion time (9.7 ± 3.0 vs 13.4 ± 2.0 minutes, P &amp;lt; 0.001) and the median incision length (5.5 vs 7.0 cm, P &amp;lt; 0.001) in the transoral group were shorter than those in the extracorporeal group. The incidence of post-operative complications (26.9% vs 23.1%, P = 0.749) and the classification of complication severity (P = 0.939) were similar between the two groups.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Intracorporeal esophagojejunostomy through a transorally inserted-anvil method may be a potentially safe approach to simplify and optimize the procedure during LTG for Siewert type 2 AEG.</jats:p> </jats:sec>

Application value of overlap guiding tube (OGT) in assisting overlap esophagojejunostomy during laparoscopic total gastrectomy for gastric/gastroesophageal junction (G/GEJ) tumors

“…Schietroma et al reported an incidence of EJAL up to 14.6% [32]. For patients with Siewert type 2 adenocarcinoma of the esophagogastric junction, the incidence of EJAL in our center reached 13.5% [4]. Therefore, in the clinical setting, EJAL is regarded as one of the most critical postoperative complications.…”

“…In recent years, although the overall incidence of gastric cancer (GC) has declined, the incidence rate of proximal GC has increased [1,2]. Surgical resection is the cornerstone of the treatment of advanced GC, and laparoscopic techniques are widely used due to their advantages, such as less invasiveness, rapid recovery, less bleeding and fewer complications [3][4][5][6][7][8][9]. At present, the feasibility of laparoscopic total gastrectomy (LTG) is still being explored, although the safety and effectiveness of laparoscopic radical gastrectomy for distal GC have been verified [3,10].…”

Relationship Between Programmed Death Ligand 1 Expression and Other Clinicopathological Features in a Large Cohort of Gastric Cancer Patients

“…All cases were reviewed by two pathologists, and histological diagnoses were confirmed without discrepancy. Clinical characteristics including age, body mass index (BMI), sex, diabetes (12), tumor location (13), histology, Lauren classification, grade, Tumor size, T stage (14), N stage (15,16), M stage (14), Ki-67 index, S-100, CD-31, D240, EBV, MMR, and, HER2 statuses, and routine blood indicators [white blood cell (WBC), mononuclear cell (MONO), eosinophilic granulocyte (EOS), neutrophil (NEU), lymphocyte (LYM), and platelet (PLT) counts, the neutrophil/lymphocyte ratio (NLR), and ABO blood group] were obtained from medical records, pathology reports, discharge summaries, and extracted from the prospective database. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.…”

Safety and Feasibility of No.12a Lymph Node Dissection by Portal Vein Approach in Radical Laparoscopic Gastrectomy for Gastric Cancer

“…In recent years, laparoscopic technology has developed rapidly, and laparoscopic gastrectomy with D2 lymphadenectomy has been recognized by the world medical community. 4 - 7 How to regularly, thoroughly and safely perform laparoscopic lymphadenectomy for GC is crucial for the therapeutic effect and prognosis of patients.…”