Browsing by Author "Gockel, Ines"

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    Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer
    (2024) Schneider, Marcel Andre; Kim, Jeesun; Berlth, Felix; Sugita, Yutaka; Grimminger, Peter P.; Wijnhoven, Bas P. L.; Overtoom, Hidde; Gockel, Ines; Thieme, Rene; Griffiths, Ewen A.; Butterworth, William; Nienhuser, Henrik; Mueller, Beat; Crnovrsanin, Nerma; Gero, Daniel; Nickel, Felix; Gisbertz, Suzanne; van Berge Henegouwen, Mark I.; Pucher, Philip H.; Khan, Kashuf; Chaudry, Asif; Patel, Pranav H.; Pera, Manuel; Dal Cero, Mariagiulia; Garcia, Carlos; Martinez Salinas, Guillermo; Kassab, Paulo; Prado Castro, Osvaldo Antonio; Norero, Enrique; Wisniowski, Paul; Putnam, Luke Randall; Lombardi, Pietro Maria; Ferrari, Giovanni; Gudaityte, Rita; Maleckas, Almantas; Prodehl, Leanne; Castaldi, Antonio; Prudhomme, Michel; Lee, Hyuk-Joon; Sano, Takeshi; Baiocchi, Gian Luca; De Manzoni, Giovanni; Giacopuzzi, Simone; Bencivenga, Maria; Rosati, Riccardo; Puccetti, Francesco; D'Ugo, Domenico; Nunobe, Souya; Yang, Han-Kwang; Gutschow, Christian Alexander
    Objective/Background:Various anastomotic and reconstruction techniques are used for minimally invasive total (miTG) and distal gastrectomy (miDG). Their effects on postoperative morbidity have not been extensively studied.Methods:MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.Results:Three major anastomotic techniques [circular stapled (CS); linear stapled (LS); and hand sewn (HS)], and 3 major bowel reconstruction types [Roux (RX); Billroth I (BI); Billroth II (BII)] were identified in miTG (n=878) and miDG (n=3334). Postoperative complications, including AL (5.2% vs 1.1%), overall (28.7% vs 16.3%), and major morbidity (15.7% vs 8.2%), as well as 90-day mortality (1.6% vs 0.5%) were higher after miTG compared with miDG. After miTG, the AL rate was higher after CS (4.3%) and HS (7.9%) compared with LS (3.4%). Similarly, major complications (LS: 9.7%, CS: 16.2%, and HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as a predictive factor for AL, overall, and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, and RX 1.2%), overall (BI: 14.5%, BII: 15.0%, and RX: 18.7%), and major morbidity (BI: 7.9%, BII: 9.1%, and RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, and RY: 1.1%%) were not affected by bowel reconstruction.Conclusions:In oncologically suitable situations, miDG should be preferred to miTG, as postoperative morbidity is significantly lower. LS should be a preferred anastomotic technique for miTG in Western Centers. Conversely, bowel reconstruction in DG may be chosen according to the surgeon's preference.