Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Nov 1;280(5):788-798.
doi: 10.1097/SLA.0000000000006470. Epub 2024 Aug 5.

Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases

Marcel André Schneider  1 , Jeesun Kim  2 , Felix Berlth  3   4 , Yutaka Sugita  5 , Peter P Grimminger  3 , Bas P L Wijnhoven  6 , Hidde Overtoom  6 , Ines Gockel  7 , René Thieme  7 , Ewen A Griffiths  8 , William Butterworth  8 , Henrik Nienhüser  9 , Beat Müller  9 , Nerma Crnovrsanin  9 , Daniel Gero  1 , Felix Nickel  10 , Suzanne Gisbertz  11   12 , Mark I van Berge Henegouwen  11   12 , Philip H Pucher  12 , Kashuf Khan  12 , Asif Chaudry  13 , Pranav H Patel  13 , Manuel Pera  14 , Mariagiulia Dal Cero  14 , Carlos Garcia  15 , Guillermo Martinez Salinas  15 , Paulo Kassab  16 , Osvaldo Antônio Prado Castro  16 , Enrique Norero  17 , Paul Wisniowski  18 , Luke Randall Putnam  18 , Pietro Maria Lombardi  19 , Giovanni Ferrari  19 , Rita Gudaityte  20 , Almantas Maleckas  20 , Leanne Prodehl  21 , Antonio Castaldi  22 , Michel Prudhomme  22 , Hyuk-Joon Lee  2 , Takeshi Sano  5 , Gian Luca Baiocchi  23 , Giovanni De Manzoni  24 , Simone Giacopuzzi  24 , Maria Bencivenga  24 , Riccardo Rosati  25 , Francesco Puccetti  25 , Domenico D'Ugo  26 , Souya Nunobe  5 , Han-Kwang Yang  2 , Christian Alexander Gutschow  1 ; GASTRODATA consortium
Collaborators, Affiliations
Multicenter Study

Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases

Marcel André Schneider et al. Ann Surg. .

Abstract

Objective/background: Various anastomotic and reconstruction techniques are used for minimally invasive total (miTG) and distal gastrectomy (miDG). Their effects on postoperative morbidity have not been extensively studied.

Methods: MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.

Results: Three major anastomotic techniques [circular stapled (CS); linear stapled (LS); and hand sewn (HS)], and 3 major bowel reconstruction types [Roux (RX); Billroth I (BI); Billroth II (BII)] were identified in miTG (n=878) and miDG (n=3334). Postoperative complications, including AL (5.2% vs 1.1%), overall (28.7% vs 16.3%), and major morbidity (15.7% vs 8.2%), as well as 90-day mortality (1.6% vs 0.5%) were higher after miTG compared with miDG. After miTG, the AL rate was higher after CS (4.3%) and HS (7.9%) compared with LS (3.4%). Similarly, major complications (LS: 9.7%, CS: 16.2%, and HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as a predictive factor for AL, overall, and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, and RX 1.2%), overall (BI: 14.5%, BII: 15.0%, and RX: 18.7%), and major morbidity (BI: 7.9%, BII: 9.1%, and RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, and RY: 1.1%%) were not affected by bowel reconstruction.

Conclusions: In oncologically suitable situations, miDG should be preferred to miTG, as postoperative morbidity is significantly lower. LS should be a preferred anastomotic technique for miTG in Western Centers. Conversely, bowel reconstruction in DG may be chosen according to the surgeon's preference.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
A, OR plot of multivariable logistic regression model assessing the influence of anastomotic technique and other variables on anastomotic leakage after minimally invasive total gastrectomy. B, OR plot of multivariable logistic regression model assessing the influence of anastomotic technique and other variables on major complications after minimally invasive total gastrectomy.
FIGURE 2
FIGURE 2
A, OR plot of multivariable logistic regression model assessing the influence of intestinal reconstruction technique and other variables on anastomotic leakage after minimally invasive distal gastrectomy. B, OR plot of multivariable logistic regression model assessing the influence of intestinal reconstruction technique and other variables on major complications after minimally invasive distal gastrectomy.
See this image and copyright information in PMC

References

    1. Moehler M, Al-Batran S-E, Andus T, et al. . S3-Leitlinie Magenkarzinom–Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs–Langversion 2.0–August 2019. AWMF-Registernummer: 032/009OL. Zeitschrift für Gastroenterologie. 2019;57:1517–1632. - PubMed
    1. Lordick F, Carneiro F, Cascinu S, et al. . Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33:1005–1020. - PubMed
    1. Kim TH, Kim IH, Kang SJ, et al. . Korean practice guidelines for gastric cancer 2022: an evidence-based, multidisciplinary approach. J Gastric Cancer. 2023;23:3–106. - PMC - PubMed
    1. Wang FH, Zhang XT, Li YF, et al. . The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (London, England). 2021;41:747–795. - PMC - PubMed
    1. Ajani JA, D’Amico TA, Bentrem DJ, et al. . Gastric cancer, version 2.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2022;20:167–192. - PubMed

Publication types