Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy

Table 1 Patient clinicopathological characteristics

Variables	IEE (n = 77)	NIEE (n = 83)	P value
Demographics
Sex (male/female)	56/21	66/17	0.278
Age (years)	61.3 ± 9.21	63.2 ± 8.85	0.463
BMI (kg/m2)	22.75 ± 3.01	23.35 ± 2.78	0.478
Comorbidities
COPD (yes/no)	11/66	17/66	0.691
Hypertension (yes/no)	15/62	14/69	0.821
Diabetes (yes/no)	9/68	13/70	0.530
Degree of tumor differentiation			0.356
High	17	14
Medium	29	33
Low	31	36
Pathological stage			0.782
IA/IB	11	9
II	25	29
IIIA/IIIB	41	45

IEE: Intraoperative endoscopic examination; NIEE: Non-intraoperative endoscopic examination; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease.

Table 2 Intraoperative management of positive leak tests in esophagojejunal anastomosis

Patient No.	Defect type	Management	Postoperative anastomotic complications	Postoperative hospital stay (days)
1	Anastomotic discontinuity	Suturing	No	10
2	Anastomotic discontinuity	Suturing	No	11
3	Anastomotic discontinuity	Suturing	No	10
4	Anastomotic bleeding	Endoscopic clamping	No	9
5	Anastomotic bleeding	Suturing	No	12
6	Anastomotic stricture	ESANR[16]	No	11
7	Full-thickness tearing	Redo anastomosis	No	13

ESANR: Esophagus-Sparing Anastomotic Narrowing Revision.

Table 3 Patient Intraoperative and postoperative characteristics, mean ± SD

Variables	IEE (n = 77)	NIEE (n = 83)	P value
Mean operation time (minutes)	308.5 ± 81.3	281 ± 75.6	0.037
Mean blood loss (mL)	105.7 ± 52.8	110.4 ± 65.2	0.745
Number of retrieved lymph nodes	28.5 ± 12.2	32.7 ± 10.8	0.178
Maximum tumor diameter (cm)	4.35 ± 2.16	4.05 ± 2.56	0.563
Proximal margin length (cm)	3.15 ± 2.05	3.26 ± 2.28	0.925
Distal margin length (cm)	7.38 ± 3.78	7.53 ± 3.21	0.672
Length of hospital stay (days)	12.94 ± 2.12	11.73 ± 1.78	0.452
Anastomosis-related complications			0.029
Anastomotic leakage	0	5
Anastomotic bleeding	0	0
Anastomotic stricture	0	1

IEE: Intraoperative endoscopic examination; NIEE: Non-intraoperative endoscopic examination.

Table 4 Multivariate logistic regression analysis of risk factors for anastomotic complications after laparoscopic total gastrectomy (n = 160)

Variable	β	SE	OR (95%CI)	P value
IEE (yes vs no)	-2.12	0.62	0.12 (0.04-0.41)	0.001
Tumor stage (III vs I/II)	0.61	0.32	1.84 (0.98-3.45)	0.058
COPD (yes vs no)	0.49	0.41	1.63 (0.73-3.64)	0.233
Hypertension (yes vs no)	0.25	0.38	1.28 (0.61-2.71)	0.512
Diabetes (yes vs no)	0.37	0.39	1.45 (0.68-3.10)	0.341
Operative time (extend per 30 minutes)	0.18	0.10	1.20 (0.98-1.46)	0.072

IEE: Intraoperative endoscopic examination; COPD: Chronic obstructive pulmonary disease; β: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval.