Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2193
Peer-review started: January 27, 2021
First decision: March 7, 2021
Revised: March 21, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: May 14, 2021
Although several methods of totally laparoscopic total gastrectomy (TLTG) have been reported, the best anastomosis technique of TLTG has not been conclusively established. Recently, we developed a modified overlap method for TLTG for overcoming these disadvantages of linear stapled method. This procedure requires less dissection around abdominal esophagus; therefore, it can create a secure esophagojejunal anastomosis with reduced tension as circular stapled method.
Whether is a more optimal anastomotic method of esophagojejunostomy in TLTG and open total gastrectomy (OTG) remains unclear. Especially, there was no report about comparing between TLTG with overlap method and OTG.
The aim of this study was to investigate the effectiveness and surgical outcomes including recurrence and survival of TLTG using the modified overlap method compared with OTG using the circular stapled method.
We performed 151 TLTG with modified overlap method and 131 OTG for gastric cancer between March 2012 and December 2018 at Asan Medical Center. We evaluated surgical and oncological outcomes between the two groups using propensity score matching. In addition, we analyzed risk factors associated with postoperative complications for improvement of postoperative management of gastric cancer surgery.
The patients who underwent TLTG were discharged earlier than those who underwent OTG. Time to first flatus and soft diet were significantly shorter in TLTG group. Pain score at all postoperative period and administration of opioid were significantly lower after the TLTG. No statistically significant difference was found between the two groups in terms of early, late and esophagojejunostomy-related complications. Significant differences were observed not with respect to 5-year recurrence free survival and overall survival.
TLTG with modified overlap method have favorable surgical and oncological outcomes compared with OTG. Furthermore, the surgeon should perform total gastrectomy cautiously and delicately especially with the patients with obese, high American Society of Anaesthesiologists score and old age.
Based on our results, we confirmed that the TLTG with modified overlap method has several advantages over OTG. However, this study has certain limitations. It is a retrospective study performed by a single experienced surgeon at a high-volume center, and the number of enrolled patients is relatively small.