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

Abstract

AIMTo evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients.METHODSWe retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.RESULTSThe TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005).CONCLUSIONThe intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.

Oncological feasibility of laparoscopic subtotal gastrectomy compared with laparoscopic proximal or total gastrectomy for cT1N0M0 gastric cancer in the upper gastric body

“…However, there are some problems associated with these procedures, namely LTG is a very recently introduced procedure compared with laparoscopic distal gastrectomy. In particular, the technique for performing esophagojejunostomy is controversial [4,5]. Gastroesophageal reflux can occur after LPG, prompting various types of reconstruction, a standard procedure not yet having been established.…”

Technical details of and prognosis for the "China stitch", a novel technique for totally laparoscopic hand-sewn esophagojejunostomy

“…These anastomosis techniques are less technically complex. They can effectively prevent the occurrence of anastomotic stenosis (23)(24)(25)(26). However, the closure of the joint opening with the Endo GIA makes the overlap procedure easier but tends to cause stenosis.…”

“…4 ± 9 . 4 ( 2 6 -4 1 ) m i n , intraoperative bleeding was 141.2 ± 24.9 (130-160) mL, and the number of resected lymph nodes was 23 ± 8 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Patients who underwent hand-sewn esophagojejunostomy did not differ significantly from those who underwent conventional mechanical esophagojejunostomy ( Table 2).…”

Current status of laparoscopic total gastrectomy

“…In Table 1, literature that compares two anastomosis methods in a single institution is shown. [51][52][53][54][55][56] Five of the studies reported that morbidity such as anastomotic leakage and stricture were not significantly different in CS and LS methods; however, one report showed that the LS method has fewer complications.…”

“…We reviewed anastomotic complications, especially those reported on leakage and stricture, in 43 extracted studies of LTG. 33,46,48,[52][53][54][55][56] We compared the surgical results of various anastomotic procedures for EJS using the CS, with attention to the insertion procedure of the anvil and the insertion site of the anastomotic device.…”