Author:
Yan Yongjia,Wang Daohan,Mahuron Kelly,Wang Xi,Lu Li,Zhao Zhicheng,Melstrom Laleh,Li Chuan,Paz I. Benjamin,Liu Jian,Fong Yuman,Li Weidong,Fu Weihua,Woo Yanghee
Abstract
Abstract
Background
Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies.
Methods
We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL.
Results
GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1–77.8) vs 44.4 (0.0–66.7), P = 0.041] and diarrhea [33.3 (0.0–66.7) vs 0.0 (0.0–66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0–33.3) vs 11.1 (0.0–33.3), P = 0.049] and eating restrictions [33.3 (16.7–58.3) vs 41.7 (16.7–66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS.
Conclusions
IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC.
Funder
SU2C Gastric Cancer Interception Award
Natural Science Foundation of Tianjin Municipal Education Commission
City of Hope
Publisher
Springer Science and Business Media LLC
Cited by
1 articles.
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