Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases.
Marcel André Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, Bas P L Wijnhoven, Hidde Overtoom, Ines Gockel, René Thieme, Ewen A Griffiths, William Butterworth, Henrik Nienhüser, Beat Müller, Nerma Crnovrsanin, Daniel Gero, Felix Nickel, Suzanne Gisbertz, Mark I van Berge Henegouwen, Philip H Pucher, Kashuf Khan, Asif Chaudry, Pranav H Patel, Manuel Pera, Mariagiulia Dal Cero, Carlos Garcia, Guillermo Martinez Salinas, Paulo Kassab, Osvaldo Antônio Prado Castro, Enrique Norero, Paul Wisniowski, Luke Randall Putnam, Pietro Maria Lombardi, Giovanni Ferrari, Rita Gudaityte, Almantas Maleckas, Leanne Prodehl, Antonio Castaldi, Michel Prudhomme, Hyuk-Joon Lee, Takeshi Sano, Gian Luca Baiocchi, Giovanni De Manzoni, Simone Giacopuzzi, Maria Bencivenga, Riccardo Rosati, Francesco Puccetti, Domenico D'Ugo, Souya Nunobe, Han-Kwang Yang, Christian Alexander Gutschow
{"title":"Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases.","authors":"Marcel André Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, Bas P L Wijnhoven, Hidde Overtoom, Ines Gockel, René Thieme, Ewen A Griffiths, William Butterworth, Henrik Nienhüser, Beat Müller, Nerma Crnovrsanin, Daniel Gero, Felix Nickel, Suzanne Gisbertz, Mark I van Berge Henegouwen, Philip H Pucher, Kashuf Khan, Asif Chaudry, Pranav H Patel, Manuel Pera, Mariagiulia Dal Cero, Carlos Garcia, Guillermo Martinez Salinas, Paulo Kassab, Osvaldo Antônio Prado Castro, Enrique Norero, Paul Wisniowski, Luke Randall Putnam, Pietro Maria Lombardi, Giovanni Ferrari, Rita Gudaityte, Almantas Maleckas, Leanne Prodehl, Antonio Castaldi, Michel Prudhomme, Hyuk-Joon Lee, Takeshi Sano, Gian Luca Baiocchi, Giovanni De Manzoni, Simone Giacopuzzi, Maria Bencivenga, Riccardo Rosati, Francesco Puccetti, Domenico D'Ugo, Souya Nunobe, Han-Kwang Yang, Christian Alexander Gutschow","doi":"10.1097/SLA.0000000000006470","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective/background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"788-798"},"PeriodicalIF":7.5000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446507/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006470","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
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.
期刊介绍:
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.