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Surgical outcomes of circular-stapled and linear-stapled esophagojejunostomy in gastric cancer: a propensity-matched analysis.

So Hyun Kang, Dr, Jan Bueno, Dr, Sa-Hong Min, Dr, Yoontaek Lee, Dr, Ki Bum Park, Dr, Young Suk Park, Prof, Sang-Hoon Ahn, Prof, Do Joong Park, Prof, Hyung-Ho Kim, Prof. Seoul National University Bundang Hospital

Aim: There have been several reports illustrating the safety and efficacy of various surgical techniques in performing laparoscopic esophagojejunostomy(EJ). This study aims to compare two established methods of EJ anastomosis – circular stapling with purse-string suture (“Lap-Jack”) and linear stapling technique – in laparoscopic total gastrectomy.

Methods: 314 patients diagnosed with gastric cancer underwent intracorporeal EJ anastomosis in laparoscopic total gastrectomy from January, 2013 to October, 2016. 254 cases used the circular stapler with purse-string “lap-jack” method, and 60 patients used the linear stapling method for EJ anastomosis. 59 were matched using propensity scores, and retrospective data for patient characteristics, surgical outcome, and post-operative complications was reviewed.

Results: The two groups showed no significant difference in age, BMI, or other clinicopathological characteristics, and there was no conversion to an open procedure. After propensity score matching analysis, the linear group had significantly shorter operating time (252.6±72.3 vs 200.1±61.7, p=<0.001) and more sufficient proximal margin (3.9±3.5 vs 4.9±3.0, p=0.022). No significant difference was found in estimated blood loss, retrieved lymph node, hospital stay, and time for first flatus. There was no postoperative mortality.

Early postoperative complication of the circular and linear group occurred in 11 (18.6%) and 16 (27.1%, p=0.381) patients respectively. EJ leakage occurred in 2 (3.4%) cases from each groups, with 1 (50%) case from both group needing radiologic or surgical intervention. No other significant difference in early complication was found.

Late complication was observed in 7 (3.3%) cases (circular=4 linear=3, p=1.000) with 1 EJ anastomosis stricture in the linear group, but there was no statistical significance.

Conclusion: Both circular stapling and linear stapling techniques are feasible and safe in performing intracorporeal EJ anastomosis during laparoscopic total gastrectomy. Linear-stapling technique had more sufficient proximal margin and shorter operating time. There was no significant difference in anastomosis related complication between the two groups. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87541

Program Number: P414

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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