Short-term outcomes after totally laparoscopic total gastrectomy with esophagojejunostomy constructed by π-shaped method versus overlap method.
BACKGROUND
Regarding the overlap anastomosis and recently introduced π-shaped anastomosis, there is no consensus on which intracorporeal esophagojejunostomy (EJS) methods are preferred using linear stapler in totally laparoscopic total gastrectomy (TLTG). This study aims to evaluate the short-term outcomes using two methods.


METHODS
Patients with upper gastric cancer underwent TLTG with either π-shaped (n = 48) or the modified overlap method using knotless barbed sutures (MOBS) (n = 37) were included in our study. Intraoperative and perioperative outcomes were compared.


RESULTS
All patients achieved R0 resection margin. The overall esophagojejunal (E-J)-related complications rate was 7.06%. There was no significant difference between the two groups in terms of postoperative complications, margin distance, numbers of lymph nodes (LNs), length of stay. In the π-shaped group, anastomosis time (19.61 ± 7.17 min vs. 27.09 ± 3.59 min, p < 0.001) was significantly lower. The consumable costs for surgery were similar (44 507.74¥ [42 933.03-46 937.29] vs. 43 718.36¥ [42 743.25-47 256.06], p = 0.825). The first defection time was significantly longer in π-shaped group (131.00 h [93.75-171.25] vs. 100.00 h [85.00-120.00], p = 0.026), whereas the other postoperative recovery parameters were similar. No mortality was observed.


CONCLUSIONS
Both methods showed similar short-term postoperative outcomes. The π-shaped technique was faster than the MOBS method without significantly increasing the supplies costs. Large prospective studies are warranted.
['Wang|Yinkui|Y|', 'Liu|Zining|Z|http://orcid.org/0000-0002-4355-6899', 'Shan|Fei|F|', 'Ying|Xiangji|X|', 'Zhang|Yan|Y|', 'Li|Shuangxi|S|http://orcid.org/0000-0002-0566-7651', 'Jia|Yongning|Y|', 'Jiang|Zijian|Z|', 'Yang|Xuesong|X|', 'Li|Bailong|B|', 'Li|Ziyu|Z|', 'Ji|Jiafu|J|']
D000368:Aged D000714:Anastomosis, Surgical D004946:Esophagostomy D005260:Female D005500:Follow-Up Studies D005743:Gastrectomy D006801:Humans D007582:Jejunostomy D010535:Laparoscopy D008297:Male D008875:Middle Aged D011379:Prognosis D012189:Retrospective Studies D013274:Stomach Neoplasms D015996:Survival Rate
total gastrectomy esophagojejunostomy gastric cancer complication laparoscopic surgery