title: Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer.
abstract: BACKGROUND
  Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients.
  
  
  METHODS
  A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded.
  
  
  RESULTS
  Overall, DST was performed in 60 patients [total gastrectomy (81.7%, n = 49/60), proximal gastrectomy (10.0%, n = 6/60), and completion gastrectomy (8.3%, n = 5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0%), and 6 patients (10.0%) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7%, n = 31/60), laparoscopic (43.3%, n = 26/60), or robotic (5.0%, n = 3/60). Anastomotic leak occurred in 6.7% (n = 4/60), while stricture independent of leak was identified in 19.0% (n = 11/58) of patients. Complications occurred in 38.3% (n = 23/60) of patients, of which 52% were classified as Clavien-Dindo grades III-V complications.
  
  
  CONCLUSIONS
  In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Choi
authors.affiliation: Department of Surgery, Marshall University Edwards Comprehensive Cancer Center, Huntington, WV, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Arrington
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Falor
authors.affiliation: Departments of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.affiliation: Departments of Anesthesia, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lew
authors.affiliation: Departments of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chao
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. bylee@coh.org.
authors.forename: Byrne
authors.initials: B
authors.lastname: Lee
authors.affiliation: Division of Surgical Oncology, Department of Surgery, SUNY Stony Brook, New York, NY, USA. joekim7@yahoo.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology*; D002277:Carcinoma / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003251:Constriction, Pathologic / Q000209:etiology; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000601:surgery* / Q000628:therapy; D017792:Surgical Stapling / Q000379:methods*; D055815:Young Adult
keywords: Double-staple technique; Gastric cancer; Proximal gastrectomy; Total gastrectomy
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