Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy
Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy
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DOI：
10.1007/s00464-019-07313-9
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发表时间：
2020-12-01
影响因子：
3.1
通讯作者：
Sakai, Yoshiharu
中科院分区：
文献类型：
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作者：
Murakami, Katsuhiro;Obama, Kazutaka;Sakai, Yoshiharu
背景 目前，对于全腹腔镜全胃切除术（TLTG）中采用何种手术方式最能减少术后并发症，尚未达成共识。本研究的目的是证明线性吻合重建在 TLTG 中 EJS 吻合相关并发症方面的优越性。方法 收集2010年1月至2016年12月期间在13家医院连续接受Roux-en-Y法TLTG重建和根治性淋巴结清扫术的829例胃癌患者的资料。根据重建方法将患者分为两组并通过倾向评分进行匹配。比较线性吻合器（LS）组和圆形吻合器（CS）组的术后 EJS 相关并发症。结果 匹配后，对每组196例患者的数据进行分析。 LS 组 EJS 相关并发症的总体发生率显着低于 CS 组（4.1% vs. 11.7%，p = 0.008）。 LS 组术后第一年 EJS 吻合口狭窄的发生率显着低于 CS 组（1.5% vs. 7.1%，p = 0.011）。尽管 LS 组未观察到出血，但 EJS 出血发生率在各组之间没有显着差异（0% vs. 2.0%，p = 0.123）。各组之间 EJS 泄漏的发生率没有显着差异（2.6% vs. 3.6%，p = 0.771）。结论 TLTG体内EJS采用线性吻合重建比环形吻合重建更安全，狭窄风险较低。
Background Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. Methods We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. Results After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%,p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%,p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%,p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%,p = 0.771). Conclusion The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.