Journal of Gastric Cancer

  • 제19권2호
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  • Pages.193-201
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  • 2019
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Intracorporeal Esophagojejunostomy Using a Circular or a Linear Stapler in Totally Laparoscopic Total Gastrectomy: a Propensity-Matched Analysis

  • Kang, So Hyun (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Cho, Yo-Seok (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Min, Sa-Hong (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Park, Young Suk (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Ahn, Sang-Hoon (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Park, Do Joong (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Kim, Hyung-Ho (Department of Surgery, Seoul National University Bundang Hospital)
  • 투고 : 2018.12.16
  • 심사 : 2019.04.09
  • 발행 : 2019.06.28
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초록

Purpose: There is no consensus on the optimal method for intracorporeal esophagojejunostomy (EJ) in laparoscopic total gastrectomy (LTG). This study aims to compare 2 established methods of EJ anastomosis in LTG. Materials and Methods: A total of 314 patients diagnosed with gastric cancer that underwent LTG in the period from January 2013 to October 2016 were enrolled in the study. In 254 patients, the circular stapler with purse-string "Lap-Jack" method was used, and in the other 60 patients the linear stapling method was used for EJ anastomosis. After propensity score matching, 58 were matched 1:1, and retrospective data for patient characteristics, surgical outcome, and post-operative complications was reviewed. Results: The 2 groups showed no significant difference in age, body mass index, or other clinicopathological characteristics. After propensity score matching analysis, the linear group had shorter operating time than the circular group ($200.3{\pm}62.0$ vs. $244.0{\pm}65.5$, $P{\leq}0.001$). Early postoperative complications in the circular and linear groups occurred in 12 (20.7%) and 15 (25.9%, P=0.660) patients, respectively. EJ leakage occurred in 3 (5.2%) patients from each group, with 1 patient from each group needing intervention of Clavien-Dindo grade III or more. Late complications were observed in 3 (5.1%) patients from the linear group only, including 1 EJ anastomosis stricture, but there was no statistical significance. Conclusions: Both circular and linear stapling techniques are feasible and safe in performing intracorporeal EJ anastomosis during LTG. The linear group had shorter operative time, but there was no difference in anastomosis complications.

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참고문헌

  1. Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, et al. Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 2009;23:2374-2379. https://doi.org/10.1007/s00464-009-0360-3
  2. Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T, et al. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 2015;38:102-112. https://doi.org/10.1016/j.asjsur.2014.09.006
  3. Ikeda T, Kawano H, Hisamatsu Y, Ando K, Saeki H, Oki E, et al. Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy: comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis. Surg Endosc 2013;27:325-332. https://doi.org/10.1007/s00464-012-2433-y
  4. Kawamura Y, Satoh S, Suda K, Ishida Y, Kanaya S, Uyama I. Critical factors that influence the early outcome of laparoscopic total gastrectomy. Gastric Cancer 2015;18:662-668. https://doi.org/10.1007/s10120-014-0392-9
  5. Kim DJ, Lee JH, Kim W. Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien-Dindo classification. Surg Endosc 2015;29:3196-3204. https://doi.org/10.1007/s00464-014-4053-1
  6. Kawamura H, Ohno Y, Ichikawa N, Yoshida T, Homma S, Takahashi M, et al. Anastomotic complications after laparoscopic total gastrectomy with esophagojejunostomy constructed by circular stapler ($OrVil^{TM}$) versus linear stapler (overlap method). Surg Endosc 2017;31:5175-5182. https://doi.org/10.1007/s00464-017-5584-z
  7. Shim JH, Yoo HM, Oh SI, Nam MJ, Jeon HM, Park CH, et al. Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 2013;16:420-427. https://doi.org/10.1007/s10120-012-0207-9
  8. Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, et al. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 2008;22:436-442. https://doi.org/10.1007/s00464-007-9446-y
  9. Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 2010;211:e25-e29. https://doi.org/10.1016/j.jamcollsurg.2010.09.005
  10. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 2009;23:2624-2630. https://doi.org/10.1007/s00464-009-0461-z
  11. Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 2009;197:e13-e17. https://doi.org/10.1016/j.amjsurg.2008.04.019
  12. Kim HH, Park YK, Uyama I. Reconstruction for esophagojejunostomy. In: Kitano S, Yang H-K, eds. Laparoscopic Gastrectomy for Cancer: Standard Techniques and Clinical Evidences. Tokyo: Springer Japan, 2012:111-118.
  13. Noh SY, Lee JH, Ahn SH, Son SY, Lee CM, Park DJ, et al. Intracorporeal end-to-side esophagojejunostomy using a laparoscopic purse-string clamp during laparoscopic total gastrectomy. J Minim Invasive Surg 2012;15:32-37. https://doi.org/10.7602/jmis.2012.15.2.32
  14. Ahn SH, Park DJ, Son SY, Lee CM, Kim HH. Single-incision laparoscopic total gastrectomy with D1+beta lymph node dissection for proximal early gastric cancer. Gastric Cancer 2014;17:392-396. https://doi.org/10.1007/s10120-013-0268-4
  15. Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, et al. Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 2009;23:2167-2171. https://doi.org/10.1007/s00464-008-9987-8
  16. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123. https://doi.org/10.1007/s10120-011-0042-4
  17. Inokuchi M, Otsuki S, Fujimori Y, Sato Y, Nakagawa M, Kojima K. Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 2015;21:9656-9665. https://doi.org/10.3748/wjg.v21.i32.9656
  18. Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol 2017;23:8553-8561. https://doi.org/10.3748/wjg.v23.i48.8553
  19. Amisaki M, Kihara K, Endo K, Suzuki K, Nakamura S, Sawata T, et al. Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy. Surg Endosc 2016;30:2994-3000. https://doi.org/10.1007/s00464-015-4588-9
  20. Kosuga T, Hiki N, Nunobe S, Ohashi M, Kubota T, Kamiya S, et al. Does the single-stapling technique for circular-stapled esophagojejunostomy reduce anastomotic complications after laparoscopic total gastrectomy? Ann Surg Oncol 2015;22:3606-3612. https://doi.org/10.1245/s10434-015-4417-3
  21. Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, et al. Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 2013;27:3683-3689. https://doi.org/10.1007/s00464-013-2945-0
  22. Park DJ, Lee JH, Lee MS, Lee HJ, Kim HH, Yang HK. Comparison of complications in end-to-side and side-to-side esophagojejunostomy after laparoscopy-assisted total gastrectomy for gastric cancer. J Minim Invasive Surg 2010;13:1-5.
  23. Chen K, Pan Y, Cai JQ, Xu XW, Wu D, Yan JF, et al. Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: a single-center 7-year experience. World J Gastroenterol 2016;22:3432-3440. https://doi.org/10.3748/wjg.v22.i12.3432

피인용 문헌

  1. A Novel Technique for Extracorporeal Anastomosis: The Bronchus Forceps Is Applied to Reinforce the Esophageal Ring vol.31, pp.11, 2019, https://doi.org/10.1089/lap.2021.0233
  2. Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis vol.21, pp.1, 2019, https://doi.org/10.1186/s12885-021-08744-1