Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
World J Surg. 2021 Aug;45(8):2501-2509. doi: 10.1007/s00268-021-06100-9. Epub 2021 Apr 1.
Esophagojejunostomy is one of the most important surgical procedures in total gastrectomy. In the past, esophagojejunostomy was exclusively performed using a circular stapler in open total gastrectomy (OTG). With the increasing frequency of its use in laparoscopic gastrectomy, esophagojejunostomy using a linear stapler has been performed in OTG. However, it is still unclear whether the use of a linear stapler in esophagojejunostomy following OTG has any advantages compared with the conventional use of a circular stapler.
A total of 298 patients who underwent OTG for gastric cancer between 2014 and 2019 were enrolled in this study. Patients were categorized into circular and linear groups (group C and group L) according to the stapler type used for the esophagojejunostomy. After propensity score matching, 136 patients (68 each in groups C and L) were selected to compare the surgical outcomes including incidence of esophagojejunostomy-related complications and postoperative nutritional status.
The median operation time was significantly longer in group L than in group C (261.5 min versus 325.5 min; P < 0.001). The incidence of esophagojejunostomy-related complications did not differ between the two groups (5.9% versus 2.9%; P = 0.68); however, no anastomotic stricture and bleeding occurred in group L. Bodyweight loss was significantly lower in group L than in group C at 6 months (15.9% versus 12.6%; P = 0.007) after surgery.
Esophagojejunostomy using a linear stapler following OTG is equally safe and possibly advantageous in anastomotic stricture, bleeding and nutritional status compared with the use of a circular stapler.
食管空肠吻合术是全胃切除术的最重要手术之一。过去，食管空肠吻合术仅在开放式全胃切除术（OTG）中使用圆形吻合器进行。随着腹腔镜胃切除术的应用越来越频繁，在 OTG 中也使用线性吻合器进行食管空肠吻合术。然而，OTG 后使用线性吻合器进行食管空肠吻合术是否比传统使用圆形吻合器具有优势仍不清楚。
本研究共纳入 2014 年至 2019 年间接受 OTG 治疗的 298 例胃癌患者。根据吻合器类型将患者分为圆形和线性两组（C 组和 L 组）。在进行倾向评分匹配后，选择了 136 名患者（每组 68 名），比较手术结果，包括食管空肠吻合术相关并发症的发生率和术后营养状况。
L 组的中位手术时间明显长于 C 组（261.5 分钟比 325.5 分钟；P<0.001）。两组食管空肠吻合术相关并发症的发生率无差异（5.9%比 2.9%；P=0.68）；然而，L 组无吻合口狭窄和出血。术后 6 个月时，L 组体重减轻明显低于 C 组（15.9%比 12.6%；P=0.007）。
与使用圆形吻合器相比，OTG 后使用线性吻合器进行食管空肠吻合术在吻合口狭窄、出血和营养状况方面同样安全，且可能具有优势。
