Skip to main content

Advertisement

SpringerLink
Log in

Hand-sewn esophagojejunostomy in transthoracic single-port assisted laparoscopic esophagogastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction with esophageal invasion > 3 cm

  • New Technology
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

An optimal method for digestive tract reconstruction (DTR) in laparoscopic radical resection of Siewert type II adenocarcinoma of esophagogastric junction (AEG) has not yet been standardized. The aim of this study was to evaluate the safety and feasibility of a hand-sewn esophagojejunostomy (EJ) technique during transthoracic single-port assisted laparoscopic esophagogastrectomy (TSLE) for Siewert type II AEG with esophageal invasion > 3 cm.

Methods

The perioperative clinical data and short-term outcomes for patients who underwent TSLE using hand-sewn EJ for Siewert type II AEG with esophageal invasion > 3 cm between March 2019 and April 2022 have been retrospectively reviewed.

Results

A total of 25 patients were eligible. All 25 patients were successfully operated. None was converted to open surgery or mortality. 84.00% of patients were male and 16.00% were female. The mean age, body mass index (BMI), and the American Society of Anesthesiologists (ASA) score were 67.88 ± 8.10 years, 21.30 ± 2.80 kg/m2, and 2.08, respectively. The average incorporated operative and hand-sewn EJ procedural times were 274.92 ± 57.46 and 23.36 ± 3.00 min, respectively. The length of extracorporeal esophageal involvement and proximal margin was 3.31 ± 0.26 cm and 3.12 ± 0.12 cm, respectively. The average time for the first oral feeding and hospital stay were 6 (3–14) and 7 (3–18) days, respectively. Two patients (8.00%) developed postoperative grade IIIa complications according to the Clavien–Dindo classification, including 1 case of pleural effusion and 1 case of anastomotic leakage, both of whom were cured by puncture drainage.

Conclusion

Hand-sewn EJ in TSLE is safe and feasible for Siewert type II AEG. This method can ensure safe proximal margins and could be a good option with an advanced endoscopic suture technique for type II tumor with esophageal invasion > 3 cm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249

    Article  PubMed  Google Scholar 

  2. Hasegawa S, Yoshikawa T (2010) Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric Cancer 13(2):63–73

    Article  PubMed  Google Scholar 

  3. Siewert JR, Feith M, Stein HJ (2005) Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 90(3):139–146

    Article  PubMed  Google Scholar 

  4. Jung MK, Schmidt T, Chon SH et al (2020) Current surgical treatment standards for esophageal and esophagogastric junction cancer. Ann NY Acad Sci 14:1–8

    Google Scholar 

  5. Sasako M, Sano T, Yamamoto S et al (2006) Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7:644–651

    Article  PubMed  Google Scholar 

  6. Lee Y, Min SH, Park KB et al (2019) Long-term outcomes of laparoscopic versus open transhiatal approach for the treatment of esophagogastric junction cancer. J Gastric Cancer 19(1):62–71

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kinoshita T, Gotohda N, Kato Y et al (2012) Laparoscopic transhiatal resection for Siewert typeII adenocarcinoma of the esophagogastric junction: operative technique and initial results. Surg Laparosc Endosc Percutaneous Tech 22:199–203

    Article  Google Scholar 

  8. Takiguchi S, Miyazaki Y, Shinno N et al (2016) Laparoscopic mediastinal dissection via an open left diaphragm approach for advanced Siewert typeII adenocarcinoma. Surg Today 46(1):129–134

    Article  PubMed  Google Scholar 

  9. Huang C, Zhao J, Liu Z et al (2020) Esophageal suspension method for hand-sewn esophagojejunostomy after totally laparoscopic total gastrectomy: a simple, safe, and feasible suturing technique. Front Oncol 10:575

    Article  PubMed  PubMed Central  Google Scholar 

  10. Puntambekar S, Badran R, Parikh H et al (2017) Technical feasibility and short-term outcome of intracorporeal hand-sewn esophagojejunostomy after laparoscopic total gastrectomy: our experience. Indian J Surg 79(6):497–503

    Article  PubMed  Google Scholar 

  11. AJCC Cancer Staging Manual Eighth Edition. 2017 22-Nov-2017 [cited; Available from:https://cancerstaging.org/About/news/Pages/UpdatedBreast-Chapter-for-8th-Edition.aspx.]

  12. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018. Gastric Cancer 24(1):1–21

    Article  Google Scholar 

  13. Luo S, Xu J, Xiong W, Li J, Luo L, Zheng Y, Zeng H, Liu Y, Yang L, Wu Z, Yang X, Wang W (2021) Feasibility and efficacy of transthoracic single-port assisted laparoscopic esophagogastrectomy for Siewert typeIIadenocarcinoma of the esophagogastric junction. Ann Transl Med 9(20):1540

    Article  PubMed  PubMed Central  Google Scholar 

  14. Xiong W, Chen Y, Zhu X et al (2022) transthoracic single-port assisted laparoscopic five-step maneuver lower mediastinal lymphadenectomy for siewert TypeIIAdenocarcinoma of the esophagogastric junction. Ann Surg Oncol. https://doi.org/10.1245/s10434-022-11369-8

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien P-A et al (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  16. Li Z, Dong J, Huang Q et al (2019) Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study. World J Surg Oncol 17:209. https://doi.org/10.1186/s12957-019-1762-x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Xiao JW, Liu ZL, Ye PC et al (2015) Clinical comparison of antrum-preserving double tract reconstruction vs roux en-Y reconstruction after gastrectomy for Siewert typesII and III adenocarcinoma of the esophagogastric junction. World J Gastroenterol 21:9999–10007

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chen X-D, He F-Q, Liao M-S et al (2021) Laparoscopic versus open transhiatal approach for adenocarcinoma of the esophagogastric junction: a systematic review and meta-analysis. Eur J Surg Oncol 47(4):778–788

    Article  PubMed  Google Scholar 

  19. Katai H, Mizusawa J, Katayama H et al (2019) Stomach cancer study group of japan clinical oncology group. single-arm confifirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer 22:999–1008

    Article  CAS  PubMed  Google Scholar 

  20. Norero E, Muñoz R, Ceroni M et al (2017) Two-layer hand-sewn esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer. J Gastric Cancer 17(3):267–276

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sun K-K, Wang Z, Peng W et al (2021) Esophagus two-step-cut overlap method in esophagojejunostomy after laparoscopic gastrectomy. Langenbecks Arch Surg 406(2):497–502

    Article  PubMed  Google Scholar 

  22. Pang W, Liu G, Zhang Y et al (2021) Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors: a prospective analysis of a case series. World J Surg Oncol 19(1):26

    Article  PubMed  PubMed Central  Google Scholar 

  23. So KO, Park JM (2011) Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer 11(4):206–211

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sun Z, Zheng X, Chen G et al (2020) Technical details of and prognosis for the “China stitch”, a novel technique for totally laparoscopic hand-sewn esophagojejunostomy. Biosci Trends 14(1):56–63

    Article  PubMed  Google Scholar 

  25. Xiaowu X, Huang C, Mou Y et al (2018) Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients. Surg Endosc 32(6):2689–2695

    Article  Google Scholar 

  26. Bissolati M, Desio M, Rosa F et al (2017) Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study. Gastric Cancer 20(1):70–82

    Article  PubMed  Google Scholar 

  27. Barbour AP, Rizk NP, Gonen M et al (2007) Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg 246(1):1–8

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sierzega M, Kolodziejczyk P, Kulig J et al (2010) Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 97(7):1035–1042

    Article  CAS  PubMed  Google Scholar 

  29. Lang H, Piso P, Stukenborg C et al (2000) Management and results of proxial anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26(2):l68-171

    Article  Google Scholar 

  30. Inokuchi M, Otsuki S, Fujimori Y et al (2015) Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 21(32):9656–9665

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kishino T, Okano K, Noge S et al (2021) Laparoscopic hand-sewn esophagojejunal anastomosis in laparoscopic proximal gastrectomy for early gastric cancer. Langenbecks Arch Surg 406(2):491–496

    Article  PubMed  Google Scholar 

  32. Morelli L, Furbetta N, Gianardi D et al (2020) Use of barbed suture without fashioning the “classical” Wirsung-jejunostomy in a modified end-to-side robotic pancreatojejunostomy. Surg Endosc 35:955–961

    Article  PubMed  PubMed Central  Google Scholar 

  33. Facy O, de Blasi V, Goergen M et al (2013) Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients. Surg Endosc 270:3841–3845

    Article  Google Scholar 

  34. Wang Z, Wei Y, Liu X et al (2021) Application value of hand-sewn anastomosis in totally laparoscopic total gastrectomy for gastric cancer. World J Surg Oncol 19(1):229

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yan JF, Chen K, Pan Y et al (2020) Laparoscopic gastrectomy using intracorporeally hand-sewn anastomosis of esophagojejunostomy, gastroduodenostomy, or gastrojejunostomy for gastric cancer. Medicine (Baltimore) 99(5):e19002

    Article  PubMed  Google Scholar 

Download references

Funding

‘Double First Class’ and High-level University Discipline Collaborative Innovation Team Project of Guangzhou University of Chinese Medicine (2021xk48).

Author information

Authors and Affiliations

  1. Surgical Department II, Baiyun Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

    Yan Chen

  2. Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510120, China

    Wenjun Xiong, Haiping Zeng, Lijie Luo, Jin Li, Yansheng Zheng & Wei Wang

  3. The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China

    Zeyu Lin, Yonghong Zhong & Tingting Yang

Authors
  1. Yan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenjun Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haiping Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lijie Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zeyu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yansheng Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yonghong Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tingting Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Wang.

Ethics declarations

Disclosures

Drs. Yan Chen, Wenjun Xiong, Haiping Zeng, Lijie Luo, Zeyu Lin, Jin Li, Yansheng Zheng, Yonghong Zhong, Tingting Yang, and Wei Wang 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.

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.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Y., Xiong, W., Zeng, H. et al. Hand-sewn esophagojejunostomy in transthoracic single-port assisted laparoscopic esophagogastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction with esophageal invasion > 3 cm. Surg Endosc 37, 4104–4110 (2023). https://doi.org/10.1007/s00464-023-10036-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10036-7

Keywords

Search

Navigation