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Reconstruction techniques and associated morbidity in minimally invasive gastrectomy for cancer: insights from the GastroBenchmark and GASTRODATA databases

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 gastrect...

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Main Authors: Schneider, Marcel André (Author) , Kim, Jeesun (Author) , Berlth, Felix (Author) , Sugita, Yutaka (Author) , Grimminger, Peter P. (Author) , Wijnhoven, Bas P. L. (Author) , Overtoom, Hidde (Author) , Gockel, Ines (Author) , Thieme, René (Author) , Griffiths, Ewen A. (Author) , Butterworth, William (Author) , Nienhüser, Henrik (Author) , Müller, Beat P. (Author) , Crnovrsanin, Nerma (Author) , Gero, Daniel (Author) , Nickel, Felix (Author) , Gisbertz, Suzanne (Author) , van Berge Henegouwen, Mark I. (Author) , Pucher, Philip H. (Author) , Khan, Kashuf (Author) , Chaudry, Asif (Author) , Patel, Pranav H. (Author) , Pera, Manuel (Author) , Dal Cero, Mariagiulia (Author) , Garcia, Carlos (Author) , Martinez Salinas, Guillermo (Author) , Kassab, Paulo (Author) , Prado Castro, Osvaldo Antônio (Author) , Norero, Enrique (Author) , Wisniowski, Paul (Author) , Putnam, Luke Randall (Author) , Lombardi, Pietro Maria (Author) , Ferrari, Giovanni (Author) , Gudaityte, Rita (Author) , Maleckas, Almantas (Author) , Prodehl, Leanne (Author) , Castaldi, Antonio (Author) , Prudhomme, Michel (Author) , Lee, Hyuk-Joon (Author) , Sano, Takeshi (Author) , Baiocchi, Gian Luca (Author) , De Manzoni, Giovanni (Author) , Giacopuzzi, Simone (Author) , Bencivenga, Maria (Author) , Rosati, Riccardo (Author) , Puccetti, Francesco (Author) , D’Ugo, Domenico (Author) , Consortium, the GASTRODATA (Author) , Nunobe, Souya (Author) , Yang, Han-Kwang (Author) , Gutschow, Christian Alexander (Author)
Format: Article (Journal)
Language:English
Published: November 2024
In: Annals of surgery
Year: 2024, Volume: 280, Issue: 5, Pages: 788-798
ISSN:1528-1140
DOI:10.1097/SLA.0000000000006470
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/SLA.0000000000006470
Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/annalsofsurgery/fulltext/2024/11000/reconstruction_techniques_and_associated_morbidity.13.aspx
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Author Notes:Marcel André Schneider, MD, PhD, Jeesun Kim, MD, MS, Felix Berlth, MD, Yutaka Sugita, MD, Peter P. Grimminger, MD, Bas P.L. Wijnhoven, MD, PhD, Hidde Overtoom, MD, PhD, Ines Gockel, MD, René Thieme, PhD, Ewen A. Griffiths, MD, William Butterworth, MD, Henrik Nienhüser, MD, Beat Müller, MD, Nerma Crnovrsanin, MD, Daniel Gero, MD, PhD, Felix Nickel, MD, Suzanne Gisbertz, MD, Mark I. van Berge Henegouwen, MD, PhD, Philip H. Pucher, MD, Kashuf Khan, MD, Asif Chaudry, MD, Pranav H. Patel, MD, PhD, Manuel Pera, MD, PhD, Mariagiulia Dal Cero, MD, Carlos Garcia, MD, Guillermo Martinez Salinas, MD, Paulo Kassab, MD, Osvaldo Antônio Prado Castro, MD, Enrique Norero, MD, Paul Wisniowski, MD, Luke Randall Putnam, MD, Pietro Maria Lombardi, MD, Giovanni Ferrari, MD, Rita Gudaityte, MD, Almantas Maleckas, MD, Leanne Prodehl, MD, Antonio Castaldi, MD, Michel Prudhomme, MD, Hyuk-Joon Lee, MD, Takeshi Sano, MD, Gian Luca Baiocchi, MD, Giovanni De Manzoni, MD, Simone Giacopuzzi, MD, Maria Bencivenga, MD, Riccardo Rosati, MD, Francesco Puccetti, MD, Domenico D’Ugo, MD, the GASTRODATA consortium, Souya Nunobe, MD, Han-Kwang Yang, MD, PhD, and Christian Alexander Gutschow, MD
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Summary: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.
Item Description:Gesehen am 27.06.2025
Physical Description:Online Resource
ISSN:1528-1140
DOI:10.1097/SLA.0000000000006470

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