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Related Experiment Video

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Overlap method versus functional method for esophagojejunal reconstruction using totally laparoscopic total

Chang Seok Ko1, Chung Sik Gong1, Byung Sik Kim1

  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

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|January 16, 2020
PubMed
Summary

The overlap method for laparoscopic intracorporeal esophagojejunostomy (EJ) in totally laparoscopic total gastrectomy (TLTG) is safer and more feasible than the functional method. This approach leads to fewer complications and better patient outcomes in gastric cancer treatment.

Keywords:
ComplicationEsophagojejunostomyGastric cancerLaparoscopic surgeryTotal gastrectomy

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Area of Science:

  • Surgical Oncology
  • Minimally Invasive Surgery
  • Gastrointestinal Surgery

Background:

  • Totally laparoscopic total gastrectomy (TLTG) is a key treatment for upper-third gastric cancer.
  • Laparoscopic intracorporeal esophagojejunostomy (EJ) is crucial for reconstruction after TLTG.
  • The safety and feasibility of functional versus overlap EJ methods require direct comparison.

Purpose of the Study:

  • To compare the safety and feasibility of functional versus overlap laparoscopic intracorporeal EJ methods.
  • To evaluate surgical outcomes and EJ-related complications between the two methods.

Main Methods:

  • Retrospective analysis of 490 patients undergoing TLTG for gastric cancer (2011-2018).
  • Propensity score matching (PSM) to create comparable groups (n=122 each) for functional and overlap EJ methods.
  • Comparison of early surgical outcomes, pain scores, and early/late complications.

Main Results:

  • No significant differences in early surgical outcomes (operative time, hospital stay, etc.).
  • Overlap EJ group showed significantly lower pain scores, fewer late complications, and reduced EJ-related complications compared to the functional group.
  • Overlap method demonstrated a lower Clavien-Dindo classification grade.

Conclusions:

  • The overlap method is a safer and more feasible approach for laparoscopic intracorporeal EJ in TLTG for gastric cancer.
  • The overlap method is associated with a significantly lower incidence of EJ-related complications.