Reduced anastomotic complications with intracorporeal esophagojejunostomy using endoscopic linear staplers (overlap method) in laparoscopic total gastrectomy for gastric carcinoma
Reduced anastomotic complications with intracorporeal esophagojejunostomy using endoscopic linear staplers (overlap method) in laparoscopic total gastrectomy for gastric carcinoma
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DOI：
10.1007/s00464-019-07362-0
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发表时间：
2020-01-30
影响因子：
3.1
通讯作者：
Ryu, Seong Yeob
中科院分区：
文献类型：
--
作者：
Jeong, Oh;Jung, Mi Ran;Ryu, Seong Yeob
背景随着手术技术和器械的进步，腹腔镜全胃切除术（LTG）中越来越多地采用胃内吻合术。然而，尽管在许多研究中已经证明了其技术可行性，但尚未证明髓内吻合术在减少术后并发症方面的益处。在这项研究中，我们研究了颅内吻合术在减少LTG术后并发症方面的影响。方法我们分析了2008年至2018年期间接受LTG的410例连续胃癌患者。其中，118例使用直线型吻合器（重叠法）进行髓内吻合，292例使用环形吻合器进行体外吻合。比较两组的短期手术结果，包括术后并发症。结果两组在年龄、性别、合并症、腹部手术史等方面无明显差异。由于存在更晚期的癌症分期，D2淋巴结清扫术更频繁地在腔内组中进行。腔内组和体外组的总体发病率分别为23.7%和27.7%（p = 0.405）。然而，内固定组的晚期并发症发生率显著较低（0.8% vs. 7.5%，p = 0.008）。关于并发症，体内组的吻合口出血（0% vs. 5.5%，p = 0.008）和吻合口狭窄（0% vs. 4.5%，p = 0.024）的发生率明显较低。在单变量和多变量分析中，美国麻醉医师协会评分和手术出血是行颅内吻合术患者术后并发症的独立预测因素。结论与体外吻合相比，使用直线型吻合器行腔内吻合可减少LTG术后吻合口出血和狭窄。未来的研究将需要确定理想的方法，在LTG内吻合。
Background With advances in surgical technique and instrumentation, intracorporeal anastomosis is increasingly being performed for laparoscopic total gastrectomy (LTG). However, the benefits of intracorporeal anastomosis in reducing postoperative complications have not been demonstrated, although its technical feasibility has been proven in many studies. In this study, we investigated the impact of intracorporeal anastomosis in reducing postoperative complications after LTG. Methods We analyzed 410 consecutive gastric cancer patients who underwent LTG between 2008 and 2018. Of these, 118 underwent intracorporeal anastomosis using linear staplers (overlap method), while 292 underwent extracorporeal anastomosis using a circular stapler. Short-term surgical outcomes including postoperative complications were compared between the two groups. Results The two groups showed no significant differences in age, sex, comorbidity, and abdominal surgery history. D2 lymph node dissection was more frequently performed in the intracorporeal group because of the presence of more advanced cancer stages. The overall morbidity in the intracorporeal and extracorporeal group was 23.7% and 27.7%, respectively (p = 0.405). However, the intracorporeal group showed a significantly lower incidence of late complications (0.8% vs. 7.5%, p = 0.008). Concerning complications, the incidence of anastomotic bleeding (0% vs. 5.5%, p = 0.008) and anastomotic stenosis (0% vs. 4.5%, p = 0.024) was significantly lower in the intracorporeal group. In univariate and multivariate analyses, American Society of Anesthesiologists score and operative bleeding were independent predictive factors for postoperative complications in patients who underwent intracorporeal anastomosis. Conclusions Intracorporeal anastomosis using linear staplers reduced anastomotic bleeding and stenosis compared to extracorporeal anastomosis after LTG. Future research will be required to determine the ideal method for intracorporeal anastomosis in LTG.