A COMPARISON OF STAPLED VERSUS HAND ESOPHAGOJEJUNOSTOMY AFTER TOTAL CASTRECTOMY FOR GASTRIC CANCER

Abstract

Esophagojejunostomy after total gastrectomy for gastric cancer is a challenging step which carries the risks of leakage, positive surgical margin and later stricture formation. in this study a retrospective analysis of the results of anastomoses which were constructed manually or via a circular stapler was done. One hundred four patients underwent total radical gastrectomy + Roux en Y esophagojejunostomy for gastric cancer in seven years, from January 1992 to December 1998. Esophagojejunostomy was manually performed in 42 (%40) cases and with a circular stapler (0 25mm) in 62 (%60) patients, Clinical anastomotic leakage occurred in eight patients (%7,6). Seven of them had hand sewn anastomosis while one (%1.6) leakage was from a stapled anastomosis. Seven patients {% 6.7) had microscopic tumor in anastomotic margin of which four was constructed manually (% 9.5) and three (% 4.8) was stapled. During follow up (1-5 years, average 20 months), anastomotic strictures developed in eight (%7,6) cases. Three (% 7.1) of them had hand sewn and five{%8.1) stapled anastomoses. Anastomotic leakage rate was significantly lower in stapled anastomoses (p=0.012). We concluded that stapled anastomosis reduces the risk of leakage in esophagojejunostomy after total gastrectomy for gastric cancer.