Lee Sejin, Lee Harim, Song Jeong Ho, Choi Seohee, Cho Minah, Son Taeil, Kim Hyoung-Il, Hyung Woo Jin
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
BMC Surg. 2020 May 12;20(1):100. doi: 10.1186/s12893-020-00746-3.
Laparoscopic total gastrectomy for gastric cancer is feasible but less commonly performed compared to laparoscopic distal gastrectomy due to technical difficulties such as reconstruction. There is no standard esophagojejunal anastomosis technique in laparoscopic total gastrectomy due to a lack of evidence.
We retrospectively analyzed data from 213 patients with gastric cancer who underwent laparoscopic total gastrectomy from October 2012 to December 2016. Of these, 109 and 104 patients underwent esophagojejunostomy with linear and circular stapling, respectively. We compared short-term postoperative outcomes, including surgical complications and anastomosis costs between both groups.
The mean operation time in the linear stapler group was longer than the circular stapler group (Linear stapler, 235.3 ± 57.9 vs. Circular stapler, 217.1 ± 55.8 min; P = 0.021); however, D2 lymph node dissection was performed more in the linear stapler group (Linear stapler, 36.7% vs. Circular stapler, 23.1%; P = 0.030). There were two anastomosis leakages in each group (Linear stapler, 1.8% vs. Circular stapler, 1.9%; P > 0.999). Anastomosis stenosis only occurred in the circular stapler group (Linear stapler, 0% vs. Circular stapler, 7.7%; P = 0.003). Although the linear stapling technique used more stapler cartridges (Linear stapler, 7.6 ± 1.1 vs. Circular stapler, 4.8 ± 0.9; P < 0.001), costs related to anastomosis were lower in the linear stapler group (Linear stapler, 1,904,679 ± 342,116 vs. Circular stapler, 2,246,150 ± 427,136KRW; P < 0.001).
Esophagojejunostomy with the linear stapling technique reduces anastomosis stenosis in laparoscopic total gastrectomy. It can be recommended as a safe and more cost-effective method for esophagojejunal anastomosis.
与腹腔镜远端胃癌切除术相比，腹腔镜全胃切除术治疗胃癌是可行的，但由于重建等技术难题，其实施频率较低。由于缺乏证据，腹腔镜全胃切除术中尚无标准的食管空肠吻合技术。
我们回顾性分析了2012年10月至2016年12月期间接受腹腔镜全胃切除术的213例胃癌患者的数据。其中，分别有109例和104例患者接受了直线缝合和圆形吻合器吻合的食管空肠吻合术。我们比较了两组患者术后的短期结局，包括手术并发症和吻合成本。
直线吻合器组的平均手术时间长于圆形吻合器组（直线吻合器组，235.3±57.9分钟 vs. 圆形吻合器组，217.1±55.8分钟；P = 0.021）；然而，直线吻合器组进行D2淋巴结清扫的比例更高（直线吻合器组，36.7% vs. 圆形吻合器组，23.1%；P = 0.030）。两组各有2例吻合口漏（直线吻合器组，1.8% vs. 圆形吻合器组，1.9%；P > 0.999）。吻合口狭窄仅发生在圆形吻合器组（直线吻合器组，0% vs. 圆形吻合器组，7.7%；P = 0.003）。尽管直线缝合技术使用的吻合器钉仓更多（直线吻合器组，7.6±1.1个 vs. 圆形吻合器组，4.8±0.9个；P < 0.001），但直线吻合器组的吻合相关成本更低（直线吻合器组，1,904,679±342,116韩元 vs. 圆形吻合器组，2,246,150±427,136韩元；P < 0.001）。
直线缝合技术进行食管空肠吻合可减少腹腔镜全胃切除术中的吻合口狭窄。它可作为一种安全且更具成本效益的食管空肠吻合方法被推荐。
