Safety & short-term outcomes of intracorporeal EJ using a transorally inserted anvil vs extracorporeal circular anastomosis during LTG for gastric cx: A propensity score matching analysis

Yanfeng Hu, MD, Xin Lu, MD, Jiang Yu, MD, Hao Liu, MD, Tingyu Mou, MD, Tao Chen, Zhenwei Deng, MD, Da Wang, MD. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China

INTRODUCTION: We performed a propensity score matching analysis to assess the safety and short-term outcomes of intracorporeal Roux-en-Y esophagojejunostomy using a transorally inserted anvil system (OrVilTM) compared with extracorporeal circular Roux-en-Y anastomosis during laparoscopic total gastrectomy for gastric cancer.

METHODS: From January 2011 to April 2014, a total of 165 consecutive patients with gastric cancer underwent either intracorporeal Roux-en-Y esophagojejunostomy (n=25) using the OrVilTM or extracorporeal circular anastomosis (n=140) during laparoscopic total gastrectomy (LTG). After generating propensity scores given the 6 covariates of sex, age, BMI, ECOG status, tumor location and size, 25 patients using the OrVilTM (intracorporeal group) were one-to-one matched with 25 patients in extracorporeal method (extracorporeal group). Morbidity and short-term outcomes were compared between the two groups.

RESUILTS: Either the time of anvil insertion (9.9±2.4min vs. 12.9±2.0min; P < 0.001) or reconstruction completion (44.4±9.4min vs. 50.1±5.4 min, P = 0.012) in the intracorporeal group was less than those in the extracorporeal group. The mean length of minilaparotomy in the intracorporeal group was smaller than that in the extracorporeal group (5.6±0.4cm vs. 7.2±1.7cm, P < 0.001). Both the intraoperative complication rate was 8.0% in each group (P = 1.000). No significant difference was observed in the estimated blood loss, the length of proximal margin, or postoperative recovery course comprised the time to first flatus, liquid, and soft diet between the two groups. No patient suffered from anastomotic-related complication in the two groups. The overall morbidity rate of 28.0% in the intracorporeal group and 32.0% in the extracorporeal group was comparable (P = 0.758).

CONCLUSION: Intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil system (OrVilTM) could be safely performed during LTG for gastric cancer.

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