Short-term Outcomes of Linear vs. Circular Stapling for Esophagojejunostomy in Gastric Cancer: an Inverse Probability of Treatment Weighting Analysis.

Purpose: Minimally invasive surgery for gastric cancer has become popular owing to its proven technical feasibility and oncological safety compared with conventional open gastrectomy. Although intracorporeal (IC) esophagojejunostomy (EJ) is commonly performed, a standardized method remains undetermined. This study compared short-term outcomes of IC EJ using circular versus linear stapling techniques.

Materials and methods: We retrospectively assessed 586 patients with gastric cancer who underwent minimally invasive proximal or total gastrectomy between 2010 and 2021. Finally, 158 and 392 patients who underwent IC EJ anastomosis with circular and linear stapling, respectively, were included in this study. Surgical outcomes and complication rates were compared between the 2 groups after adjusting for confounding variables using inverse probability of treatment weighting.

Results: The total number of complications did not differ between the 2 groups (P=0.138). However, major complications occurred more frequently in the circular stapling group than in the linear stapling group (15.2% vs. 7.4%, P=0.041). There was no significant intergroup difference in EJ-related anastomotic leakage (1.9% vs. 2.1%, P=0.916). The incidence of anastomotic stenosis was lower in the linear stapling group than in the circular stapling group (10.8% vs. 0.5%, P<0.001). Additionally, the pain score on postoperative day 1 was lower in the linear stapling group (3.48 vs. 3.09, P<0.001).

Conclusions: Both linear and circular stapling can be used in IC EJ. However, linear stapling is a more suitable option because it has several advantages, including a reduced incidence of EJ-related stenosis and less postoperative pain attributable to differences in the length of the incision.