Short-term outcomes of intracorporeal esophagojejunostomy using the transorally inserted anvil versus extracorporeal circular XXXX during laparoscopic total gastrectomy for @entity356 : a propensity score matching analysis.

@entity1 @entity5 @entity190 @entity254 @entity532 @entity356
BACKGROUND: To assess the short-term outcomes of intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil (OrVil) compared with extracorporeal circular Roux-en-Y @entity254 during laparoscopic total gastrectomy (LTG) for @entity356 . METHODS: From January 2011-April 2014, a total of 165 consecutive @entity1 with @entity356 underwent either intracorporeal Roux-en-Y esophagojejunostomy (n  =  25) using the Orvil or extracorporeal circular @entity254 (n  =  140) during LTG. After generating propensity scores with six covariates, including gender, age, body mass index (BMI), Eastern Cooperative Oncology Group performance status, @entity5 location, and @entity5 size, 25 @entity1 undergoing the OrVil method (intracorporeal group) were one-to-one matched with 25 @entity1 undergoing the extracorporeal method (extracorporeal group). The short-term outcomes were compared between the two groups. RESULTS: Both groups were balanced regarding baseline variables. The total operative time was not significantly different between the two groups (216.5      24.9  min versus 224.0      30.5  min, P  =  0.344), whereas either the duration of anvil insertion (9.9      2.4  min versus 12.9      2.0  min, P  <  0.001) or reconstruction completion (44.4      9.4  min versus 50.1      5.4  min, P  =  0.012) in the intracorporeal group was less. The mean length of minilaparotomy in the intracorporeal group was shorter (5.6      0.4  cm versus 7.2      1.7  cm, P  <  0.001). No significant differences were observed in intraoperative complication rate, estimated @entity190 , length of proximal margin, or postoperative recovery course (including the time to first flatus, liquid resumption, liquid, and soft diet) between the two groups. No @entity1 suffered from @entity532 . The overall morbidity rates of 28.0% in the intracorporeal group and 32.0% in the extracorporeal group were comparable (P  =  0.758). CONCLUSIONS: Intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil system may be a safe procedure during LTG for @entity356 . However, a longer follow-up in a well-designed randomized controlled trial is necessary to more thoroughly evaluate this technique.
