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Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers

BACKGROUND: Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optim...

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Autores principales: Yan, Yongjia, Wang, Daohan, Mahuron, Kelly, Wang, Xi, Lu, Li, Zhao, Zhicheng, Melstrom, Laleh, Li, Chuan, Paz, I. Benjamin, Liu, Jian, Fong, Yuman, Li, Weidong, Fu, Weihua, Woo, Yanghee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506935/
https://www.ncbi.nlm.nih.gov/pubmed/37442910
http://dx.doi.org/10.1245/s10434-023-13771-2
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author Yan, Yongjia
Wang, Daohan
Mahuron, Kelly
Wang, Xi
Lu, Li
Zhao, Zhicheng
Melstrom, Laleh
Li, Chuan
Paz, I. Benjamin
Liu, Jian
Fong, Yuman
Li, Weidong
Fu, Weihua
Woo, Yanghee
author_facet Yan, Yongjia
Wang, Daohan
Mahuron, Kelly
Wang, Xi
Lu, Li
Zhao, Zhicheng
Melstrom, Laleh
Li, Chuan
Paz, I. Benjamin
Liu, Jian
Fong, Yuman
Li, Weidong
Fu, Weihua
Woo, Yanghee
author_sort Yan, Yongjia
collection PubMed
description BACKGROUND: Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies. METHODS: We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL. RESULTS: GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1–77.8) vs 44.4 (0.0–66.7), P = 0.041] and diarrhea [33.3 (0.0–66.7) vs 0.0 (0.0–66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0–33.3) vs 11.1 (0.0–33.3), P = 0.049] and eating restrictions [33.3 (16.7–58.3) vs 41.7 (16.7–66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS. CONCLUSIONS: IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-023-13771-2.
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spelling pubmed-105069352023-09-20 Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers Yan, Yongjia Wang, Daohan Mahuron, Kelly Wang, Xi Lu, Li Zhao, Zhicheng Melstrom, Laleh Li, Chuan Paz, I. Benjamin Liu, Jian Fong, Yuman Li, Weidong Fu, Weihua Woo, Yanghee Ann Surg Oncol Thoracic Oncology BACKGROUND: Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies. METHODS: We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL. RESULTS: GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1–77.8) vs 44.4 (0.0–66.7), P = 0.041] and diarrhea [33.3 (0.0–66.7) vs 0.0 (0.0–66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0–33.3) vs 11.1 (0.0–33.3), P = 0.049] and eating restrictions [33.3 (16.7–58.3) vs 41.7 (16.7–66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS. CONCLUSIONS: IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-023-13771-2. Springer International Publishing 2023-07-13 2023 /pmc/articles/PMC10506935/ /pubmed/37442910 http://dx.doi.org/10.1245/s10434-023-13771-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Thoracic Oncology
Yan, Yongjia
Wang, Daohan
Mahuron, Kelly
Wang, Xi
Lu, Li
Zhao, Zhicheng
Melstrom, Laleh
Li, Chuan
Paz, I. Benjamin
Liu, Jian
Fong, Yuman
Li, Weidong
Fu, Weihua
Woo, Yanghee
Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers
title Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers
title_full Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers
title_fullStr Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers
title_full_unstemmed Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers
title_short Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers
title_sort different methods of minimally invasive esophagojejunostomy after total gastrectomy for gastric cancer: outcomes from two experienced centers
topic Thoracic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506935/
https://www.ncbi.nlm.nih.gov/pubmed/37442910
http://dx.doi.org/10.1245/s10434-023-13771-2
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