Intracorporeal esophagojejunostomy using a linear stapler in laparoscopic total gastrectomy: comparison with circular...

Area of Science:

• Minimally invasive surgery
• Surgical oncology
• Gastrointestinal surgery

Background:

• Laparoscopic total gastrectomy (LTG) for gastric cancer presents reconstruction challenges.
• A standardized esophagojejunal anastomosis (EJA) technique for LTG is lacking due to insufficient evidence.

Purpose of the Study:

• To compare short-term postoperative outcomes of EJA using linear versus circular stapling in LTG.
• To evaluate surgical complications and anastomosis costs between the two stapling techniques.

Main Methods:

• Retrospective analysis of 213 patients undergoing LTG from October 2012 to December 2016.
• Patients were divided into two groups: linear stapling (n=109) and circular stapling (n=104) for EJA.
• Comparison of operation time, D2 lymph node dissection rates, anastomotic complications, and costs.

Main Results:

• The linear stapler group had a longer mean operation time but a higher rate of D2 lymph node dissection.
• Anastomosis leakage rates were similar (1.8% vs. 1.9%).
• Anastomosis stenosis occurred only in the circular stapler group (7.7%), while the linear stapler group had 0% stenosis. Linear stapling incurred lower anastomosis-related costs despite using more cartridges.

Conclusions:

• Linear stapling for EJA in LTG is associated with a significant reduction in anastomosis stenosis.
• This technique is a safe and more cost-effective option for esophagojejunal reconstruction in laparoscopic total gastrectomy.