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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

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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.

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Authors and Affiliations

  1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Han-Kwang Yang, Seong-Ho Kong & Hyuk-Joon Lee

  2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

    Woo ** Hyung & Hyoung-Il Kim

  3. Department of Surgery, Ajou University School of Medicine, Suwon, Korea

    Sang-Uk Han

  4. Department of Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, **ju, Korea

    Young-Jun Lee

  5. Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea

    Joong-Min Park & Jong Won Kim

  6. Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea

    Gyu Seok Cho

  7. Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea

    Oh Kyoung Kwon

  8. Department of Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

    Wook Kim

  9. Department of Surgery, Keimyung University School of Medicine, Daegu, Korea

    Seung Wan Ryu

  10. Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

    Sung-Ho **

  11. Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

    Sung ** Oh

  12. Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Keun Won Ryu

  13. Department of Surgery, Dong-A University College of Medicine, Busan, Korea

    Min-Chan Kim

  14. Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea

    Hye Seong Ahn

  15. Department of Surgery, Chonnam National University Hwasoon Hospital, Hwasun, Korea

    Young Kyu Park

  16. Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea

    Yong Ho Kim

  17. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea

    Sun-Hwi Hwang

  18. Department of Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 56 Dongsuro, Bupyong-Gu, Inchon, 21431, Korea

    **-Jo Kim

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  1. Han-Kwang Yang
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  22. **-Jo Kim
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Correspondence to **-Jo Kim.

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Disclosures

Drs. Han-Kwang Yang, Woo ** 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 **, Sung ** Oh, Keun Won Ryu, Min-Chan Kim, Hye Seong Ahn, Young Kyu Park, Yong Ho Kim, Sun-Hwi Hwang, Jong Won Kim, and **-Jo Kim have no conflicts of interest or financial ties to disclose.

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Yang, HK., Hyung, W.J., Han, SU. et al. 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. Surg Endosc 35, 1156–1163 (2021). https://doi.org/10.1007/s00464-020-07480-0

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