T-Shaped Functional End to End Anastomosis as an Alternative Method for Esophagojejunostomy after Totally Laparoscopic Total Gastrectomy for Gastric Cancer

Background: The functional end-to-end anastomosis (FEEA) and overlap methods for reconstruction after totally laparoscopic total gastrectomy (TLTG) are technically challenges. We developed a T-shaped FEEA to facilitate technique. This study aimed to compare the short- and long-term outcomes between the T-shaped FEEA and overlap methods after TLTG for gastric cancer (GC). Method: This cohort study enrolled 84 patients who underwent TLTG for GC using linear stapler for reconstruction between August-2015 and October-2020. Among them, 40 patients underwent FEEA, while 44 patients underwent overlap method. Short-term outcomes encompassed operative characteristics, postoperative morbidity, and mortality. Long-term outcomes included anastomosis-related complications and 1-year nutritional status. Oncologic outcomes were assessed regarding 1-, 3-, and 5- year overall survival (OS) and disease-free survival (DFS). Results: : There were no significant differences between the T-shaped FEEA and overlap methods in terms of the early surgical outcomes such as operating time, time of performing anastomosis, time of the first flatus, overall morbidities and mortality, and postoperative hospital stays. The esophagojejunostomy leakage and stenosis rates were similar between the groups (5.0% and 2.6% vs. 6.8% and 0.0%, respectively). The changing of reduction in weight, hemoglobin level, and albumin after 1-year postoperation were equivalent. Five-year OS and DFS were comparable between the two groups (70% and 57% vs. 51% and 41%, respectively). Conclusions: : There was no significant difference in surgical outcomes and long-term survival between the modified FEEA and overlap methods. The T-shaped FEEA may be an alternative method for reconstruction after TLTG for GC.