Kyogoku Noriaki, Ebihara Yuma, Shichinohe Toshiaki, Nakamura Fumitaka, Murakawa Katsuhiko, Morita Takayuki, Okushiba Shunichi, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Department of Surgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-ku, Sapporo, Hokkaido, Japan.
Langenbecks Arch Surg. 2018 Jun;403(4):463-471. doi: 10.1007/s00423-018-1678-x. Epub 2018 May 9.
We used propensity score matching to compare the complication rates after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using a circular or a linear stapler.
We retrospectively enrolled all patients who underwent curative LTG between November 2004 and March 2016. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Clinicopathological characteristics and surgical outcomes were compared.
We identified 66 propensity score-matched pairs among 379 patients who underwent LTG. There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. In the circular and linear groups, the rate of all complications (Clavien-Dindo [CD] classification ≥ I; 21 vs. 26%, respectively; p = 0.538), complications more severe than CD grade III (14 vs. 14%, respectively; p = 1.000), and occurrence of EJS leakage and stenosis more severe than CD grade III (5 vs. 2%, p = 0.301; 9 vs. 8%, p = 0.753, respectively) were comparable.
There is no difference in the postoperative complication rate related to the type of stapler used for EJS after LTG.
我们采用倾向评分匹配法，比较使用圆形吻合器或线性吻合器行腹腔镜全胃切除术（LTG）并食管空肠吻合术（EJS）后的并发症发生率。
我们回顾性纳入了2004年11月至2016年3月期间接受根治性LTG的所有患者。根据后续EJS所使用的吻合器类型，将患者分为圆形组和线性组。使用以下倾向评分协变量对两组患者进行匹配：年龄、性别、体重指数、美国麻醉医师协会身体状况分级、淋巴结清扫范围以及日本胃癌分类分期。比较临床病理特征和手术结果。
在379例行LTG的患者中，我们确定了66对倾向评分匹配的患者。两组在中位手术时间、淋巴结清扫范围、切除淋巴结数量、转为开放手术的比例或由日本内镜外科学会认证的外科医生所进行的手术数量方面，均无显著组间差异。在圆形组和线性组中，所有并发症发生率（Clavien-Dindo[CD]分级≥I；分别为21%和26%；p = 0.538）、比CD III级更严重的并发症发生率（分别为14%和14%；p = 1.000）以及比CD III级更严重的EJS渗漏和狭窄发生率（分别为5%对2%，p = 0.301；9%对%，p = 0.753）相当。
LTG术后与EJS所使用吻合器类型相关的术后并发症发生率无差异。
