The safety of esophagojejunostomy via a transorally inserted-anvil method vs extracorporeal anastomosis using a circular stapler during total gastrectomy for Siewert type 2 adenocarcinoma of the esophagogastric junction

作     者：Xin-Hua Chen Yan-Feng Hu Jun Luo Yue-Hong Chen Hao Liu Tian Lin Hao Chen Guo-Xin Li Jiang Yu 

作者机构：Department of General SurgeryNanfang HospitalSouthern Medical UniversityGuangzhouGuangdongP.R.China 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2020年第8卷第3期

页      面：242-251,I0002页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：This work was supported by Medtronic,National Key Clinical Specialities Construction Program of China[No.121] Science and Technology Planning Project of Guangdong Province[2013B021800313] Special Funds for the Cultivation of Guangdong College Students’Scientific and Technological Innovation[pdjha0094] 

主　　题：adenocarcinoma of the esophagogastric junction laparoscopic total gastrectomy esophagojejunostomy anastomotic leakage 

摘      要：Background:Intracorporeal esophagojejunostomy via a transorally inserted-anvil method during laparoscopic total gastrectomy(LTG)for upper gastric cancer has been demonstrated to be feasible,but the use of this assessment exclusively for Siewert type 2 adenocarcinoma of the esophagogastric junction(AEG)has not been ***:A total of 428 consecutive gastric-cancer patients who underwent LTG in Nanfang Hospital from January 2008 to December 2016 were *** these patients,98 were classified as Siewert type 2 *** patients underwent intracorporeal esophagojejunostomy through either a transorally inserted-anvil method(n=27)or extracorporeal anastomosis usinga circular stapler(n=71).After generating propensity scores with covariates that were associated with developing anastomotic leakage,26 patients who underwent esophagojejunostomy via the transorally inserted-anvil method(transoral group)were 1:1 matched with 26 patients who underwent the procedure via extracorporeal anastomosis using a circular stapler(extracorporeal group).The safety after 30 days post-operatively was compared between the two ***:The transoral group and extracorporeal group were balanced regarding the baseline *** operative time,reconstruction duration,number of dissected lymph nodes,length of the proximal resectionmargins,estimated blood loss,intra-operative complication rate,and post-operative recovery course were not significantly different between the two *** mean anvil-insertion completion time(9.763.0 vs 13.462.0minutes,P0.001)and the median incision length(5.5 vs 7.0 cm,P0.001)in the transoral group were shorter than those in the extracorporeal *** incidence of post-operative complications(26.9%vs 23.1%,P=0.749)and the classification of complication severity(P=0.939)were similar between the two ***:Intracorporeal esophagojejunostomy through a transorally inserted-anvil method may be a potentially safe approach to simplify