Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy: A Substantive Retrospective Propensity Score Matched Series.
Mittelstädt A, Reitberger H, Fleischmann J, Elshafei M, Brunner M, Anthuber A, Krautz C, Lucio M, Merkel S, Grützmann R, Weber G (2022)
Publication Language: English
Publication Type: Journal article
Publication year: 2022
Journal
Book Volume: 3
Journal Issue: 3
DOI: 10.1097/AS9.0000000000000195
Abstract
BACKGROUND: Anastomotic leakage (AL) and stenosis (AS) are two of the most severe postoperative complications after total gastrectomy with esophagojejunostomy. The stapler diameter can be chosen by the surgeon. Therefore, this study aims to assess the correlation between the stapler size as main independent variable as well as other different risk factors and AL and AS. METHODS: We conducted a retrospective analysis of data from 356 patients who underwent open total gastrectomy between 2000 and 2018, mostly due to gastric cancer (96.9%). After propensity score matching the outcome parameters AL and AS were compared between the two stapler size groups. We also assessed different risk factors for AL and AS in cancer patients using multivariate analysis. RESULTS: Small circular stapler diameter (21/25 mm; n = 147 vs 28/29/31 mm; n = 209) was identified as a significant risk factor for the occurrence of AL (10% vs 4% for smaller vs larger staplers; P = 0.042). In multivariate analysis for the occurrence of AL an ASA score ≥ 3 could be identified as a risk factor (OR 2.85; 95% CI = 1.13-7.15; P = 0.026). Additionally, smaller stapler size could be identified as a risk factor for AS (OR small 1.00, OR large 0.24; 95% CI: 0.06-0.97; P = 0.045). AL was associated with lower survival (18.1 vs 38.16 months; P = 0.0119). CONCLUSION: The application of a larger circular stapler for esophagojejunostomy in open total gastrectomy shows significantly lower rates of AL and stenosis. Therefore, the largest possible stapler diameter should be applied.
Authors with CRIS profile
Anke Mittelstädt
Department of Surgery
Helena Reitberger
Department of Surgery
Julia Fleischmann
Department of Surgery
Moustafa Elshafei
Maximilian Brunner Lehrstuhl für Allgemein- und Viszeralchirurgie Christian Krautz Department of Surgery Susanne Merkel Department of Surgery Robert Grützmann Lehrstuhl für Allgemein- und Viszeralchirurgie Georg Weber Department of Surgery
Maximilian Brunner Lehrstuhl für Allgemein- und Viszeralchirurgie Christian Krautz Department of Surgery Susanne Merkel Department of Surgery Robert Grützmann Lehrstuhl für Allgemein- und Viszeralchirurgie Georg Weber Department of Surgery
Involved external institutions
Krankenhaus Nordwest
Germany (DE)
Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (HMGU) / Helmholtz Munich
Germany (DE)
Germany (DE)
Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (HMGU) / Helmholtz Munich
Germany (DE)
How to cite
APA:
Mittelstädt, A., Reitberger, H., Fleischmann, J., Elshafei, M., Brunner, M., Anthuber, A.,... Weber, G. (2022). Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy: A Substantive Retrospective Propensity Score Matched Series. Annals of Surgery Open, 3(3). https://doi.org/10.1097/AS9.0000000000000195
MLA:
Mittelstädt, Anke, et al. "Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy: A Substantive Retrospective Propensity Score Matched Series." Annals of Surgery Open 3.3 (2022).
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