Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy.
OBJECTIVE
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, I(2) = 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, I(2) = 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 OrVil™ device was used (8.8%) compared with other procedures (1.0% to 3.6%).


CONCLUSIONS
The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the OrVil™ device was used.
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Mikito
M
Inokuchi
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Sho
S
Otsuki
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Yoshitaka
Y
Fujimori
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Yuya
Y
Sato
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Masatoshi
M
Nakagawa
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Kazuyuki
K
Kojima
D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D004946:Esophagostomy / Q000009:adverse effects* / Q000295:instrumentation; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007582:Jejunostomy / Q000009:adverse effects* / Q000295:instrumentation; D010535:Laparoscopy / Q000009:adverse effects; D016017:Odds Ratio; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
Anastomosis; Complication; Gastrectomy; Gastric cancer; Laparoscopic