Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy follo
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Linear or circular stapler? A propensity score‑matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy Katsuhiro Murakami1,14 · Kazutaka Obama1,14 · Shigeru Tsunoda1,14 · Shigeo Hisamori1,14 · Tatsuto Nishigori1,14 · Koya Hida1,14 · Seiichiro Kanaya2,14 · Seiji Satoh3,14 · Dai Manaka4,14 · Michihiro Yamamoto5,14 · Yoshio Kadokawa6,14 · Atsushi Itami7,14 · Hiroshi Okabe8,14 · Hiroaki Hata9,14 · Eiji Tanaka10,14 · Yoshito Yamashita11,14 · Masato Kondo12,14 · Hisahiro Hosogi13,14 · Nobuaki Hoshino1 · Shiro Tanaka15 · Yoshiharu Sakai1,14 Received: 15 July 2019 / Accepted: 28 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. Methods We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Rouxen-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. Results After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p = 0.771). Conclusion The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis. Keywords Totally laparoscopic total gastrectomy · Linear stapler · Circular stapler · Esophagojejunostomy · Anastomotic stenosis Gastric cancer is one of the most common malignancies and is the second leading cause of cancer death worldwide [1]. Laparoscopic surgery has become an option for the treatment of gastric cancer with remarkable advances in laparoscopic instruments and improved surgical techniques. The use of laparoscopic gastrectomy has been spreading Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-019-07313-9) contains supplementary material, which is available to authorized users. * Kazutaka
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