Safety of two and a half layered esophagojejunal anastomosis in total gastrectomy for gastric cancer

Abstract

Objective: For gastric cancer patients undergoing total gastrectomy, the esophagojejunal anastomosis is the main site of postoperative anastomotic leakage. How to improve the safety of the esophagojejunal anastomosis is a hot topic. This study evaluated the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy for gastric cancer. Methods: A retrospective cohort study was conducted. Clinical data of 764 gastric cancer patients, who were diagnosed as gastric adenocarcinoma by preoperative gastroscopicbiopsy and were judged to be able to complete R0 resection by imaging examination, in the Affiliated Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from May 2015 to May 2019 were retrospectively collected and analyzed. two and a half layered esophagojejunal anastomosis was used in the treatment group (295 cases), and the routine anastomosis was used in the control group (469 cases). Postoperative complicating including anastomosis-assisted complications were compared between the two groups. Results: The baseline data of two groups were not significantly different (all P>0.05). All the patients successfully completed the operation. In observation group and control group, the total operative time [(140.7±27.0) minutes vs. (139.6±22.8) minutes], intraoperative blood loss [(200.6±111.0) ml vs. (214.4±114.1) ml], anastomosis time [(20.4±4.3) minutes vs. (19.9±4.6) minutes], time to first flatus [(4.1±1.1) days vs. (4.2±1.1) days], time to fluid diet [(5.4±1.0) days vs. (5.5±0.9) days], time to postoperative nasointestinal tube removal [(9.8±3.2) days vs. (10.0±2.3) days], and postoperative hospital stay [(15.4±6.5) days vs. (15.9±5.6) days] were not significantly different (all P>0.05). Compared to the control group, the treatment group had lower rates of anastomosis-associated complications [1.7% (5/295) vs. 4.7% (22/469), χ(2)=4.768, P=0.029] and anastomotic leakage [1.0% (3/295) vs.3.4% (16/469), χ(2)=4.282, P=0.039]. The differences in the incidence of anastomotic stenosis and anastomotic bleeding were not statistically significant between the two groups (both P>0.05). In the treatment group and control group, rates of total postoperative complication [34.2% (101/295) vs. 32.2% (151/469), χ(2)=0.838, P=0.360] and severe complication [Clavinen-Dindo grade III and above; 4.7% (14/295) vs. 7.2% (34/469), Z=-1.465, P=0.143] were not significantly different as well. Conclusion: Two and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy for gastric cancer and can reduce anastomosis-associated complications.