Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy
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 in...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2022-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000195 |
| _version_ | 1827855991023075328 |
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| author | Anke Mittelstädt, Dr. med. Helena Reitberger, Dr. med. Julia Fleischmann, Dr. med. dent. Moustafa Elshafei, Dr. med. Maximilian Brunner, PD Dr. med. Anna Anthuber Christian Krautz, PD Dr. med. Marianna Lucio, Dr. Susanne Merkel, Prof. Dr. med. Robert Grützmann, Prof. Dr. > med. Georg F. Weber, Prof. Dr. med. |
| author_facet | Anke Mittelstädt, Dr. med. Helena Reitberger, Dr. med. Julia Fleischmann, Dr. med. dent. Moustafa Elshafei, Dr. med. Maximilian Brunner, PD Dr. med. Anna Anthuber Christian Krautz, PD Dr. med. Marianna Lucio, Dr. Susanne Merkel, Prof. Dr. med. Robert Grützmann, Prof. Dr. > med. Georg F. Weber, Prof. Dr. med. |
| author_sort | Anke Mittelstädt, Dr. med. |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T12:19:17Z |
| format | Article |
| id | doaj.art-07174156e2da49799a26dcd5d28a9812 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:19:17Z |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-07174156e2da49799a26dcd5d28a98122023-08-30T06:10:24ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932022-09-0133e19510.1097/AS9.0000000000000195202209000-00026Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With EsophagojejunostomyAnke Mittelstädt, Dr. med.0Helena Reitberger, Dr. med.1Julia Fleischmann, Dr. med. dent.2Moustafa Elshafei, Dr. med.3Maximilian Brunner, PD Dr. med.4Anna Anthuber5Christian Krautz, PD Dr. med.6Marianna Lucio, Dr.7Susanne Merkel, Prof. Dr. med.8Robert Grützmann, Prof. Dr. > med.9Georg F. Weber, Prof. Dr. med.10From the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, Germany† Department of Bariatric and Metabolic Medicine, Clinic Northwest, Frankfurt, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, Germany‡ Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.From the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyFrom the * Department of General and Visceral Surgery, Friedrich-Alexander University, Erlangen, GermanyBackground:. 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.http://journals.lww.com/10.1097/AS9.0000000000000195 |
| spellingShingle | Anke Mittelstädt, Dr. med. Helena Reitberger, Dr. med. Julia Fleischmann, Dr. med. dent. Moustafa Elshafei, Dr. med. Maximilian Brunner, PD Dr. med. Anna Anthuber Christian Krautz, PD Dr. med. Marianna Lucio, Dr. Susanne Merkel, Prof. Dr. med. Robert Grützmann, Prof. Dr. > med. Georg F. Weber, Prof. Dr. med. Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy Annals of Surgery Open |
| title | Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy |
| title_full | Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy |
| title_fullStr | Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy |
| title_full_unstemmed | Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy |
| title_short | Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy |
| title_sort | effect of circular stapler diameter on anastomotic leakage rate and stenosis after open total gastrectomy with esophagojejunostomy |
| url | http://journals.lww.com/10.1097/AS9.0000000000000195 |
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