Overlap method versus functional method for esophagojejunal reconstruction using totally laparoscopic total gastrectomy
To determine the optimal method of laparoscopic intracorporeal esophagojejunal reconstruction by comparing overlap and functional methods for gastric cancer treatment.
We retrospectively collected and analyzed the data of 490 consecutive patients who underwent totally laparoscopic total gastrectomy (TLTG) using the overlap method (125 patients) and functional method (365 patients) as treatment for upper body gastric cancer between January 2011 and May 2018. One-to-one propensity score matching (PSM) was performed to compare age, sex, body mass index, American Society of Anesthesiologist score, presence of comorbidity, number of comorbidities, clinical T stage, clinical nodal stage, clinical TNM stage, history of previous abdominal surgery, and combined surgery. After PSM, patients (122 who underwent TLTG using the overlap method and 122 underwent TLTG using the functional method) were grouped to compare surgical outcomes including esophagojejunostomy (EJ)-related complications.
Pain score was significantly lower after the overlap method (functional method [6.73±2.06] vs overlap method [6.25±1.84], P<0.05). However, no statistically significant difference was found between the two groups in terms of other early surgical outcomes such as operative time, time to first flatus, hospital day after surgery, transfusion during surgery, transfusion after surgery and administration of analgesics. TLTG using the overlap method was shown to be associated with significantly fewer EJ-related complications (functional method [n=8, 6.56%] vs overlap method [n=1, 0.82%], P<0.05), fewer late complications (overlap method [n=4, 3.28%] vs functional method [n=15, 12.30%]), and lower Clavien–Dindo classification grade than TLTG using the functional method (P<0.05).
The overlap method should be considered a safe and feasible esophagojejunal reconstruction method, being associated with fewer EJ-related complications than the functional method in TLTG.
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