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Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer : a propensity score-matched study

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Title: Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer : a propensity score-matched study
Authors: Kyogoku, Noriaki Browse this author
Ebihara, Yuma Browse this author →KAKEN DB
Shichinohe, Toshiaki Browse this author →KAKEN DB
Nakamura, Fumitaka Browse this author
Murakawa, Katsuhiko Browse this author
Morita, Takayuki Browse this author
Okushiba, Shunichi Browse this author
Hirano, Satoshi Browse this author →KAKEN DB
Keywords: Gastric cancer
Laparoscopic total gastrectomy
Postoperative complications
Propensity score matching
Issue Date: Jun-2018
Publisher: Springer
Journal Title: Langenbeck's archives of surgery
Volume: 403
Issue: 4
Start Page: 463
End Page: 471
Publisher DOI: 10.1007/s00423-018-1678-x
PMID: 29744579
Abstract: Purpose: We used propensity score matching to compare the complication rates after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using a circular or a linear stapler. Methods: We retrospectively enrolled all patients who underwent curative LTG between November 2004 and March 2016. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Clinicopathological characteristics and surgical outcomes were compared. Results: We identified 66 propensity score-matched pairs among 379 patients who underwent LTG. There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. In the circular and linear groups, the rate of all complications (Clavien-Dindo [CD] classification ≥ I; 21 vs. 26%, respectively; p = 0.538), complications more severe than CD grade III (14 vs. 14%, respectively; p = 1.000), and occurrence of EJS leakage and stenosis more severe than CD grade III (5 vs. 2%, p = 0.301; 9 vs. 8%, p = 0.753, respectively) were comparable. Conclusions: There is no difference in the postoperative complication rate related to the type of stapler used for EJS after LTG.
Rights: The final publication is available at
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 海老原 裕磨

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