A. Falor1, A. Choi1, S. Merchant1, M. Lew2, B. Lee1, I. B. Paz1, R. Nelson3, J. Kim1 1City Of Hope National Medical Center,Division Of Surgical Oncology,Duarte, CA, USA 2City Of Hope National Medical Center,Department Of Anesthesia,Duarte, CA, USA 3City Of Hope National Medical Center,Department Of Biostatistics,Duarte, CA, USA
Introduction: Several surgical techniques to perform esophagoenteric anastomosis for total/proximal gastrectomy have been described including the double-stapled technique (DST), which involves a circular stapled anastomosis across the stapled end of the esophagus. Since prior reports on DST for gastric cancer are limited, our objective was to examine rates of anastomotic leak and stricture with DST for esophagoenteric anastomosis in patients with gastric cancer.
Methods: A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2014. All DST were performed using the OrVil™ and an end-to-end anastomosis (EEA) stapler. Patient and treatment-related variables were tabulated. Anastomotic leaks were defined as perianastomotic extravasation of oral contrast on radiographic imaging or anastomotic disruption on endoscopy. Stricture was defined as symptomatic anastomotic narrowing requiring dilation.
Results: Of 55 patients who underwent DST between 2006 and 2014, total gastrectomy was performed in 44/55 (80%), proximal gastrectomy in 6/55 (11%) and completion gastrectomy in 5/55 (9%). Eleven patients (20%) had multi-visceral resection at the time of gastrectomy. Fifty patients (91%) had adenocarcinoma on final pathology, and 22 patients (40%) received neoadjuvant chemotherapy. Six patients (10.9%) had undergone radiation therapy prior to completion gastrectomy for recurrent disease. Operative approach was open (n=26/55; 47.2%), laparoscopic (n=26/55; 47.2%), and robotic (n=3/55; 5.4%). The leak rate was 5/55 (9%) occurring at a median of 14 days (5-20 days). The stricture rate was 12/55 (21.8%) occurring at a median of 86 days (40-405 days). Leak and stricture rates improved with increased experience. During the 2012-2014 period, the rates of anastomotic leak and stricture were 0/19 (0%) and 3/19 (15.7%), respectively. The overall complication rate was 21/55 (38.1%) of which 60% were classified as Clavien-Dindo grade III-V complications. On multivariate analysis, none of the aforementioned variables correlated with risk for leak or stricture.
Conclusion: In the largest Western series of DST esophagoenteric anastomoses for gastric cancer, our experience demonstrates that DST is a safe and effective technique with low rates of anastomotic leak and stricture.