A novel delta-shaped esophagojejunostomy after robotic total gastrectomy

Esophagojejunostomy following minimally invasive total gastrectomy is technically challenging. We developed a novel intracorporeal delta-shaped esophagojejunostomy using linear staplers following robotic total gastrectomy (RTG). The aim of this study was to verify its safety and feasibility, as compared with established techniques.

Of the 85 consecutive RTG cases performed between February 2021 and March 2025, 74 patients were retrospectively analyzed. The cohort consisted of 24 patients who underwent delta-shaped anastomosis, 29 with functional end-to-end anastomosis (FEEA), and 21 with the overlap method. We compared surgical outcomes, including operative variables, anastomotic leakage, and postoperative complications up to 30 days.

No anastomotic leakage occurred in the delta group, whereas one case occurred in the overlap group. The incidence of Clavien-Dindo grade ≥ III complications did not differ significantly among groups. The median anastomotic time with delta-shaped anastomosis was significantly shorter than that with the overlap method (32.0 vs. 45.0 min, p = 0.006) but significantly longer than that with FEEA (23.0 min, p < 0.001). The esophageal resection length was comparable between the delta-shaped anastomosis and FEEA groups; however, the delta-shaped technique required significantly less esophageal mobilization (p < 0.001). No anastomotic strictures were observed within 30 days postoperatively.

Intracorporeal delta-shaped esophagojejunostomy after RTG is a safe and feasible procedure with favorable short-term outcomes. Achieving anastomosis with less esophageal mobilization under equivalent transection conditions may offer a technical advantage. Further large-scale studies with long-term follow-up are warranted.