Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Table 1 Characteristics, merit and demerit of different esophagojejunostomy anastomosis techniques

Anastomosis surgeon	Characteristics	Merit	Demerit
Uyama et al[12]	The anastomosis line is vertical with esophageal long axis	Anastomotic is large enough	The number of anastomosis linear staplers is much
	Jejunum is located in the right side of the esophagus.
Matsui et al[37]	Complete the anastomosis before severed esophagus	The number of anastomosis linear staplers is reduced	Probably develop dysphagia 6 mo after operation
	Close the stoma and resect specimens at the same time
	Jejunum is located in the right side of the esophagus
Lee et al[13]	Suture esophagus, jejunum and right angle of diaphragm after anastomosis	Reduce the incidence of esophageal hiatal hernia and anastomotic fistula	Increase the operation time
	Jejunum is located in the right side of the esophagus
Okabe et al[38]	Before anastomosis, the specimens was removed	The size of anastomotic stoma is bigger	The technique is difficult
	Jejunum is located in the left side of the esophagus
Inaba et al[29]	Overlap anastomosis	Isoperistaltic anastomosis meets the physiological needs	The jejunum is free and difficult for anastomosis
	Divide the jejunum before anastomosis
Matsui et al[39]	Overlap anastomosis	Isoperistaltic anastomosis meets the physiological needs	The jejunum is free and difficult for anastomosis
	Divide the esophagus after anastomosis

Table 2 Structure of EORTC QLC-C30 and EORTC QLQ-STO22

Scale	Number of constituting items
EORTC QLQ-C30
Global health status/QoL scale1	2
Functional scales1
Physical functioning	5
Role functioning	2
Emotional functioning	4
Cognitive functioning	2
Social functioning	2
Symptom scales2
Fatigue	3
Nausea and vomiting	2
Pain	2
Dyspnoea	1
Insomnia	1
Appetite loss	1
Constipation	1
Diarrhoea	1
Financial difficulties	1
EORTC-QLQ-STO222
Dysphagia	3
Chest and abdominal pain	4
Reflux	3
Eating restrictions	4
Anxieties	3
Dry mouth	1
Taste problem	1
Body image	1
Hair loss	2

¹Higher scores represent better QoL;

²Higher scores represent worse QoL. EORTC QLQ indicates European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire; QoL: Quality-of-life.

Table 3 Demographic and clinical characteristics of patients in the two groups

	All patients			Propensity-matched patients
	Group T (n = 51)	Group A (n = 456)	P value	Group T (n = 51)	Group A (n = 102)	P value
Age (mean ± SD, yr)	55.5 ± 12.1	61.6 ± 11.2	< 0.001	55.5 ± 12.1	55.9 ± 11.0	0.916
Gender			< 0.001			1.000
Male	34	345		34	68
Female	17	111		17	34
Charlson comorbidity index			0.281			0.608
0	48	418		48	92
1-2	3	38		3	10
BMI (mean ± SD, kg/m2)	22.5 ± 13.1	22.3 ± 13.5	0.919	22.5 ± 13.1	22.6 ± 12.8	0.965
Tumor size (mean ± SD, cm)	4.5 ± 1.5	4.9 ± 1.3	0.041	4.5 ± 1.5	4.7 ± 1.7	0.142
Tumor location			< 0.001			0.177
Upper third	4	188		4	12
Middle third	34	169		34	76
Whole	13	99		13	14
Histology type			0.453			0.482
Differentiation	47	416		47	97
Undifferentiation	4	40		4	5
Preoperative albumin (mean ± SD, g/L)	40.8 ± 4.3	39.1 ± 5.2	0.025	40.8 ± 4.3	40.6 ± 4.6	0.796
Depth of infiltration (T)			0.174			0.643
T1	15	82		15	23
T2	8	83		8	18
T3	10	135		10	16
T4a	18	166		18	45
Nodal status (N)			0.729			0.534
N0	21	190		21	34
N1	11	77		11	18
N2	5	66		5	10
N3	14	123		14	40
UICC stage			0.319			0.502
I	13	78		13	18
II	17	159		17	40
III	21	219		21	44

BMI: Body mass index; UICC stage: 7^th edition of the International Union against Cancer.

Table 4 Operative variables of the patients

	All patients			Propensity-matched patients
	Group T (n = 51)	Group A (n = 456)	P value	Group T (n = 51)	Group A (n = 102)	P value
Operative time, min (mean ± SD)	209.3 ± 41.0	203.6 ± 49.3	0.427	209.3 ± 41.0	200.5 ± 55.6	0.318
Blood loss, mL (mean ± SD)	48.3 ± 38.5	98.4 ± 149.1	0.017	48.3 ± 38.5	105.4 ± 147.9	0.008
Harvested LNs (mean ± SD)	44.5 ± 15.0	41.2 ± 14.2	0.237	44.5 ± 15.0	42.6 ± 15.2	0.465
Time to first flatus, days (mean ± SD)	3.8 ± 1.2	3.5 ± 1.7	0.220	3.8 ± 1.2	3.6 ± 1.2	0.332
Time to fluid diet, days (mean ± SD)	5.6 ± 1.4	5.6 ± 1.6	1	5.6 ± 1.4	5.5 ± 1.9	0.739
Postoperative days (mean ± SD)	12.6 ± 4.3	14.7 ± 8.9	0.097	12.6 ± 4.3	15.4 ± 8.9	0.035
hospitalization costs, yuan	75450 ± 20038	73308 ± 21932	0.505	75450 ± 20038	70407 ± 13254	0.065
Chemotherapy	33	310	0.635	33	78	0.123

LN: Lymph node.

Table 5 Morbidity and mortality associate with anastomosis

	All patients			Propensity-matched patients
	Group T, % (n = 456)	Group A, % (n = 51)	P value	Group T, % (n = 102)	Group A, % (n = 51)	P value
Morbidity	1 (2.0)	27 (5.9)	0.893	1 (1.9)	6 (11.8)	0.552
Anastomotic fistula	1	22		1	4
Anastomotic hemorrhage	0	1		0	0
Anastomotic obstruction	0	4		0	2
Mortality	0	0	/	0	0	/

Table 6 Constituent items of pain of EORTC-QLQ-C30 and dysphagia of EORTC-QLQ-STO22 as compared between group T and group A

	Propensity-matched patients
	Group T (n = 44)	Group A (n = 89)	P value
Constituent items of pain of EORTC-QLQ-C30
Have you felt pain?			0.018
Not at all	28	66
A little	12	7
Quite a lot	3	14
Very much	1	2
Have your life affected by pain?			0.271
Not at all	39	73
A little	4	7
Quite a lot	1	9
Very much	0	0
Constituent items of dysphagia of EORTC-QLQ-STO22
Have you felt difficult to eat solid food?			0.039
Not at all	26	31
A little	11	32
Quite a lot	7	21
Very much	0	5
Have you felt difficult to eat liquid of soft food?			0.275
Not at all	38	67
A little	5	15
Quite a lot	1	7
Very much	0	0
Have you felt difficult to drink water?			0.194
Not at all	39	80
A little	5	5
Quite a lot	0	4
Very much	0	0