Safety of transorally-inserted anvil for esophagojejunostomy in laparoscopic total gastrectomy

Abstract

Background: To assess the safety of transorally-inserted anvil (TOA) for use during esophagojejunostomy (EJ) reconstruction during laparoscopic total gastrectomy (LTG). Methods: Between March 2009 and December 2011, 39 consecutive open total gastrectomies (OTGs) and 36 LTGs using TOA for gastric cancer were comparatively evaluated. We investigated postoperative complications, using the Clavien-Dindo classification. To evaluate the effect of a learning period in using TOA for LTG, we also investigated shifts in the patterns of complications and changes in total operation time over the course of the study. Results: The patient characteristics at baseline were not different between both groups, except for the extent of lymphadenectomy (P < 0.001) and depth of tumor invasion (P = 0.003). Multivariate analysis revealed that TOA usage elevated the occurrence of infectious complications significantly (OR = 3.32, P = 0.042), but was not associated with El-related complications. TOA usage did not need a learning period for the length of time required to complete the operation, or the likelihood of developing an El-related or infectious complication. Conclusions: TOA use for El during LTG is relatively simple and easy enough not to require a learning period for surgeons. This procedure did not elevated the occurrence of El-related complications compared to circular stapling in open surgery, but it does require special prevention efforts to avoid infectious complications. (C) 2013 Elsevier Ltd. All rights reserved.