Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage I proximal gastric cancer: results of a single-arm multicenter phase II clinical trial in Korea, KLASS 03

Han Kwang Yang, Woo Jin Hyung, Sang Uk Han, Young Jun Lee, Joong Min Park, Gyu Seok Cho, Oh Kyoung Kwon, Seong Ho Kong, Hyoung Il Kim, Hyuk Joon Lee, Wook Kim, Seung Wan Ryu, Sung Ho Jin, Sung Jin Oh, Keun Won Ryu, Min Chan Kim, Hye Seong Ahn, Young Kyu Park, Yong Ho Kim, Sun Hwi HwangJong Won Kim, Jin Jo Kim

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Abstract

Background: Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ). Methods: The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups. Results: There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020). Conclusions: The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.

Original languageEnglish
JournalSurgical endoscopy
DOIs
Publication statusAccepted/In press - 2020

All Science Journal Classification (ASJC) codes

  • Surgery

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    Yang, H. K., Hyung, W. J., Han, S. U., Lee, Y. J., Park, J. M., Cho, G. S., Kwon, O. K., Kong, S. H., Kim, H. I., Lee, H. J., Kim, W., Ryu, S. W., Jin, S. H., Oh, S. J., Ryu, K. W., Kim, M. C., Ahn, H. S., Park, Y. K., Kim, Y. H., ... Kim, J. J. (Accepted/In press). Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage I proximal gastric cancer: results of a single-arm multicenter phase II clinical trial in Korea, KLASS 03. Surgical endoscopy. https://doi.org/10.1007/s00464-020-07480-0