Abstract
Background
The transorally inserted anvil (OrVil™) is frequently selected for esophagojejunostomy after laparoscopic total gastrectomy (LTG) because of its versatility. During anastomosis with OrVil™, the double stapling technique (DST) or hemi-double stapling technique (HDST) can be selected by overlapping the linear stapler and the circular stapler. However, no studies have reported the differences between the methods and their clinical significance.
Methods
A randomized controlled clinical trial with a parallel assignment and single-blind outcomes assessment analysis was conducted. Patients with gastric cancer eligible for LTG who met the selection criteria were randomized. Preoperative characteristics and perioperative and postoperative outcomes were compared between the DST and HDST. The primary endpoint was an anastomosis-related complication, and the secondary endpoints were perioperative outcomes and postoperative complications, excluding anastomosis-related complications.
Results
Thirty patients with gastric cancer were eligible and randomized. LTG and esophagojejunostomy were successfully performed in all patients, without conversion to laparotomy. Preoperative characteristics, excluding preoperative chemotherapy, were not significantly different between the two groups. One anastomotic leakage of Clavien–Dindo classification grade ≥ IIIa was observed in the DST, although no significant difference was found between the two groups (6.6% vs. 0%, P = 0.30). In the HDST, one case of anastomotic stricture required endoscopic balloon dilation. No significant differences were found in operative time, whereas the anastomosis time was significantly shorter in the HDST than in the DST (47.5 ± 15.8 vs. 38.2 ± 8.8 min, P = 0.028). Except for anastomosis-related complications, postoperative complications (P = 0.282) and postoperative hospital stay for the DST and HDST were not significantly different.
Conclusions
No superiority was found between the DST and HDST with OrVil™ in esophagojejunostomy of LTG for gastric cancer with respect to postoperative complications, whereas the HDST may be preferable in terms of the simplicity of the surgical technique.
Graphical abstract
Similar content being viewed by others
References
Lu L, Mullins CS, Schafmayer C, Zeißig S, Linnebacher M (2021) A global assessment of recent trends in gastrointestinal cancer and lifestyle-associated risk factors. Cancer Commun (Lond) 41(11):1137–1151
Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34(12):1350–1357
Etoh T, Honda M, Kumamaru H, Miyata H, Yoshida K, Kodera Y, Kakeji Y, Inomata M, Konno H, Seto Y, Kitano S, Hiki N (2018) Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc 32(6):2766–2773
Huang Y, Liu G, Wang X, Zhang Y, Zou G, Zhao Z, Cao Z, Zhao H, Yuan X, Zhang C (2021) Safety and feasibility of total laparoscopic radical resection of Siewert type II gastroesophageal junction adenocarcinoma through the left diaphragm and left thoracic auxiliary hole. World J Surg Oncol 19(1):73
Shim JH, Yoo HM, Oh SI, Nam MJ, Jeon HM, Park CH, Song KY (2013) Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 16(3):420–427
Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23(11):2624–2630
Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ, Kwon OK, Kong SH, Kim HI, Lee HJ, Kim W, Ryu SW, Jin SH, Oh SJ, Ryu KW, Kim MC, Ahn HS, Park YK, Kim YH, Hwang SH, Kim JW, Cho GS (2019) A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer 22(1):214–222
Kawaguchi Y, Shiraishi K, Akaike H, Ichikawa D (2019) Current status of laparoscopic total gastrectomy. Ann Gastroenterol Surg 3(1):14–23
Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, Terashima M (2019) Esophagojejunal anastomotic leakage following gastrectomy for gastric cancer. Surg Today 49(3):187–196
Sierzega M, Kolodziejczyk P, Kulig J (2010) Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 97(7):1035–1042
Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M (2013) Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol 20(5):1575–1583
Ojima E, Ikeda T, Noguchi T, Watanabe H, Yokoe T, Ito H, Konishi N, Tonouchi H (2014) Laparoscopic sigmoidectomy using a hemi-double-stapling technique. Surg Laparosc Endosc Percutan Tech 24(2):e41-42
Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, Haruta H, Hyodo M, Sata N, Lefor AT, Yasuda Y (2013) Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27(10):3683–3689
Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24(1):1–21
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Marangoni G, Villa F, Shamil E, Botha AJ (2012) OrVil™-assisted anastomosis in laparoscopic upper gastrointestinal surgery: friend of the laparoscopic surgeon. Surg Endosc 26(3):811–817
Jung YJ, Kim DJ, Lee JH, Kim W (2013) Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVil) following laparoscopic total or proximal gastrectomy—comparison with extracorporeal anastomosis. World J Surg Oncol 11:209
Shida A, Mitsumori N, Fujioka S, Takano Y, Iwasaki T, Takahashi N, Ishibashi Y, Omura N, Yanaga K (2016) Comparison of short-term and long-term clinical outcomes between laparoscopic and open total gastrectomy for patients with gastric cancer. Surg Laparosc Endosc Percutan Tech 26(4):319–323
Sakuramoto S, Kikuchi S, Futawatari N, Moriya H, Katada N, Yamashita K, Watanabe M (2010) Technique of esophagojejunostomy using transoral placement of the pretilted anvil head after laparoscopic gastrectomy for gastric cancer. Surgery 147(5):742–747
Kunisaki C, Makino H, Oshima T, Fujii S, Kimura J, Takagawa R, Kosaka T, Akiyama H, Morita S, Endo I (2011) Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc 25(4):1300–1305
Kachikwu EL, Trisal V, Kim J, Pigazzi A, Ellenhorn JD (2011) Minimally invasive total gastrectomy for gastric cancer: a pilot series. J Gastrointest Surg 15(1):81–86
Liao GQ, Ou XW, Liu SQ, Zhang SR, Huang W (2013) Laparoscopy-assisted total gastrectomy with trans-orally inserted anvil (OrVil™): a single institution experience. World J Gastroenterol 19(5):755–760
LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE (2013) Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol 20(9):2975–2983
Chong-Wei K, Dan-Lei C, Dan D (2013) A modified technique for esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy. Surg Laparosc Endosc Percutan Tech 23(3):e109-115
Xie JW, Huang CM, Zheng CH, Li P, Wang JB, Lin JX, Jun L (2013) A safe anastomotic technique of using the transorally inserted anvil (OrVil) in Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy for proximal malignant tumors of the stomach. World J Surg Oncol 11:256
Cianchi F, Macrì G, Indennitate G, Mallardi B, Trallori G, Biagini MR, Badii B, Staderini F, Perigli G (2014) Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience. Springerplus 3:434
Hiyoshi Y, Oki E, Ando K, Ito S, Saeki H, Morita M, Baba H, Maehara Y (2014) Outcome of esophagojejunostomy during totally laparoscopic total gastrectomy: a single-center retrospective study. Anticancer Res 34(12):7227–7232
Ito H, Inoue H, Odaka N, Satodate H, Onimaru M, Ikeda H, Takayanagi D, Nakahara K, Kudo SE (2014) Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study. Surg Endosc 28(6):1929–1935
Kwon Y, Cho SI, Kwon YJ, Yang KS, Jang YJ, Kim JH, Park SH, Mok YJ, Park S (2014) Safety of transorally-inserted anvil for esophagojejunostomy in laparoscopic total gastrectomy. Eur J Surg Oncol 40(3):330–337
Wang H, Hao Q, Wang M, Feng M, Wang F, Kang X, Guan WX (2015) Esophagojejunostomy after laparoscopic total gastrectomy by OrVil™ or hemi-double stapling technique. World J Gastroenterol 21(29):8943–8951
Hu YF, Wang D, Lin T, Mou TY, Liu H, Chen T, Deng ZW, Lu X, Yu J, Li GX (2015) An automatically contamination-avoiding technique for intracorporeal esophagojejunostomy using a transorally inserted anvil during laparoscopic total gastrectomy for gastric cancer. World J Surg Oncol 13:154
Salih AE, Bass GA, D’Cruz Y, Brennan RP, Smolarek S, Arumugasamy M, Walsh TN (2015) Extending the reach of stapled anastomosis with a prepared OrVil™ device in laparoscopic oesophageal and gastric cancer surgery. Surg Endosc 29(4):961–971
Lu X, Hu Y, Liu H, Mou T, Deng Z, Wang D, Yu J, Li G (2016) Short-term outcomes of intracorporeal esophagojejunostomy using the transorally inserted anvil versus extracorporeal circular anastomosis during laparoscopic total gastrectomy for gastric cancer: a propensity score matching analysis. J Surg Res 200(2):435–443
Brenkman HJ, Correa-Cote J, Ruurda JP, van Hillegersberg R (2016) A step-wise approach to total laparoscopic gastrectomy with jejunal pouch reconstruction: how and why we do it. J Gastrointest Surg 20(11):1908–1915
Yu WH, Chen K, Pan Y, Zhu HP, Gao JQ, Pan JH, Zheng XY, Wang XF (2017) Intracorporeal esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy for upper gastric cancer. Int J Clin Exp Pathol 10(9):9704–9709
Yamamoto M, Kawano H, Yamaguchi S, Egashira A, Minami K, Morita M, Sakaguchi Y, Toh Y (2017) Technical and survival risks associated with esophagojejunostomy by laparoscopic total gastrectomy for gastric carcinoma. Surg Laparosc Endosc Percutan Tech 27(3):197–202
Li X, Hong L, Ding D, Liu Y, Niu G, Li L, Wang X, Li X, Ke C (2017) Comparison of OrVil™ and RPD in laparoscopic total gastrectomy for gastric cancer. Surg Endosc 31(11):4773–4779
Kawamura H, Ohno Y, Ichikawa N, Yoshida T, Homma S, Takahashi M, Taketomi A (2017) Anastomotic complications after laparoscopic total gastrectomy with esophagojejunostomy constructed by circular stapler (OrVil(™)) versus linear stapler (overlap method). Surg Endosc 31(12):5175–5182
Choi AH, Arrington A, Falor A, Nelson RA, Lew M, Chao J, Lee B, Kim J (2016) Assessment of the double-staple technique for esophagoenteric anastomosis in gastric cancer. J Gastrointest Surg 20(4):688–692
Yasukawa D, Hori T, Kadokawa Y, Kato S, Machimoto T, Hata T, Aisu Y, Sasaki M, Kimura Y, Takamatsu Y, Ito T, Yoshimura T (2017) Impact of stepwise introduction of esophagojejunostomy during laparoscopic total gastrectomy: a single-center experience in Japan. Ann Gastroenterol 30(5):564–570
Yoshikawa K, Shimada M, Higashijima J, Tokunaga T, Nishi M, Takasu C, Kashihara H, Ishikawa D (2018) Usefulness of the transoral anvil delivery system for esophagojejunostomy after laparoscopic total gastrectomy: a single-institution comparative study of transoral anvil delivery system and the overlap method. Surg Laparosc Endosc Percutan Tech 28(2):e40–e43
Tokuhara T, Nakata E, Tenjo T, Kawai I, Kondo K, Ueda H, Tomioka A (2019) Stenosis after esophagojejunostomy with the hemi-double-stapling technique using the transorally inserted anvil (OrVil™) in Roux-en-Y reconstruction with its efferent loop located on the patient’s left side following laparoscopic total gastrectomy. Surg Endosc 33(7):2128–2134
Ishibashi Y, Oka S, Kanda S, Yube Y, Kohira Y, Kaji S, Egawa H, Jianzhong W, Zhang S, Fukunaga T (2020) Hemi-double stapling technique performed with a transorally inserted anvil for esophagojejunostomy in the surgical treatment of gastric cancer. Asian J Endosc Surg 13(2):168–174
Chen XH, Hu YF, Luo J, Chen YH, Liu H, Lin T, Chen H, Li GX, Yu J (2020) The safety of esophagojejunostomy via a transorally inserted-anvil method vs extracorporeal anastomosis using a circular stapler during total gastrectomy for Siewert type 2 adenocarcinoma of the esophagogastric junction. Gastroenterol Rep (Oxf) 8(3):242–251
Nomura E, Kayano H, Seki T, Abe R, Yoshii H, Uda S, Kazuno A, Izumi H, Yamamoto S, Mukai M, Makuuchi H (2021) Preventive procedure for stenosis after esophagojejunostomy using a circular stapler and transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy and total gastrectomy involving reduction of anastomotic tension. BMC Surg 21(1):47
Foley DM, Emanuwa EJE, Knight WRC, Baker CR, Kelly M, McEwan R, Zylstra J, Davies AR, Gossage JA (2021) Analysis of outcomes of a transoral circular stapled anastomosis following major upper gastrointestinal cancer resection. Dis Esophagus 34(11):doab004
Wang WP, Gao Q, Wang KN, Shi H, Chen LQ (2013) A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg 37(5):1043–1050
Roumen RM, Rahusen FT, Wijnen MH, Croiset van Uchelen FA (2000) “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption. Dis Colon Rectum 43(4):522–525
Kawasaki K, Fujino Y, Kanemitsu K, Goto T, Kamigaki T, Kuroda D, Kuroda Y (2007) Experimental evaluation of the mechanical strength of stapling techniques. Surg Endosc 21(10):1796–1799
Kataoka M, Masaoka A, Hayashi S, Honda H, Hotta T, Niwa T, Honda K (1989) Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy. Ann Surg 209(1):99–104
Campos GM, Jablons D, Brown LM, Ramirez RM, Rabl C, Theodore P (2010) A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy: the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg 37(6):1421–1426
Kinoshita T, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T (2013) Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery. Surg Endosc 27(1):146–153
Amisaki M, Kihara K, Endo K, Suzuki K, Nakamura S, Sawata T, Shimizu T (2016) Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy. Surg Endosc 30(7):2994–3000
Duan W, Liu K, Fu X, Shen X, Chen J, Su C, Yu P, Zhao Y (2017) Semi-end-to-end esophagojejunostomy after laparoscopy-assisted total gastrectomy better reduces stricture and leakage than the conventional end-to-side procedure: a retrospective study. J Surg Oncol 116(2):177–183
Sumner SM, Regier PJ, Case JB, Ellison GW (2019) Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008–2018). Vet Surg 48(7):1188–1193
Terashima M, Iwasaki Y, Mizusawa J, Katayama H, Nakamura K, Katai H, Yoshikawa T, Ito Y, Kaji M, Kimura Y, Hirao M, Yamada M, Kurita A, Takagi M, Boku N, Sano T, Sasako M (2019) Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer, the short-term safety and surgical results: Japan Clinical Oncology Group Study (JCOG0501). Gastric Cancer 22(5):1044–1052
Acknowledgements
None.
Funding
This study received no external funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Suguru Yamauchi, Satoshi Kanda, Yutaro Yoshimoto, Akira Kubota, Kenki Tsuda, Yukinori Yube, Sanae Kaji, Shinichi Oka, Hajime Orita, Malcolm V Brock, Shinji Mine and Tetsu Fukunaga have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Yamauchi, S., Kanda, S., Yoshimoto, Y. et al. Double stapling technique versus hemi-double stapling technique for esophagojejunostomy with OrVil™ after laparoscopic total gastrectomy: a single-blind, randomized clinical trial. Surg Endosc 37, 5931–5942 (2023). https://doi.org/10.1007/s00464-023-10068-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-023-10068-z