Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9656-9665
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9656
Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy
Mikito Inokuchi, Sho Otsuki, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Kazuyuki Kojima
Mikito Inokuchi, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Sho Otuski, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Kazuyuki Kojima, Department of Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Author contributions: Inokuchi M and Kojima K contributed to the writing of this manuscript; Fujimori Y, Otsuki S, Nakagawa M and Sato Y contributed to the gathering, review, and analysis of the related literature.
Conflict-of-interest statement: The authors declare that they have no competing financial interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mikito Inokuchi, MD, PhD, Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. m-inokuchi.srg2@tmd.ac.jp
Telephone: +81-3-58035261 Fax: +81-3-58030139
Received: April 23, 2015
Peer-review started: April 24, 2015
First decision: May 18, 2015
Revised: June 2, 2015
Accepted: July 8, 2015
Article in press: July 8, 2015
Published online: August 28, 2015
Processing time: 127 Days and 1.4 Hours
Abstract

AIM: To investigate the anastomotic complications of esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG), we reviewed retrospective studies.

METHODS: A literature search was conducted in PubMed for studies published from January 1, 1994 through January 31, 2015. The search terms included “laparoscopic,”“total gastrectomy,” and “gastric cancer.” First, we selected 16 non-randomized controlled trials (RCTs) comparing LTG with open total gastrectomy (OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system (NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS.

RESULTS: The overall incidence of anastomotic leakage associated with EJS was 3.0% (30 of 984 patients) among LTG procedures and 2.1% (31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG (odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I2 = 0%). Anastomotic stenosis related to EJS was reported in 72 (2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG (OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I2 = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar (1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the OrVilTM device was used (8.8%) compared with other procedures (1.0% to 3.6%).

CONCLUSION: The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the OrVilTM device was used.

Keywords: Gastric cancer; Laparoscopic; Gastrectomy; Anastomosis; Complication

Core tip: In this updated meta-analysis of non-randomized controlled trials comparing laparoscopic total gastrectomy (LTG) and open total gastrectomy, the incidence of anastomotic leakage was similar, and that of anastomotic stenosis was slightly, but not significantly, higher when LTG was performed. The incidence of anastomotic stenosis was relatively high for new procedures that utilize a trans-orally inserted anvil (OrVilTM) in reported case series of LTG.