BACKGROUND With advances in surgical technique and instrumentation, intracorporeal anastomosis is increasingly being performed for laparoscopic total gastrectomy (LTG). However, the benefits of intracorporeal anastomosis in reducing postoperative complications have not been demonstrated, although its technical feasibility has been proven in many studies. In this study, we investigated the impact of intracorporeal anastomosis in reducing postoperative complications after LTG. METHODS We analyzed 410 consecutive gastric cancer patients who underwent LTG between 2008 and 2018. Of these, 118 underwent intracorporeal anastomosis using linear staplers (overlap method), while 292 underwent extracorporeal anastomosis using a circular stapler. Short-term surgical outcomes including postoperative complications were compared between the two groups. RESULTS The two groups showed no significant differences in age, sex, comorbidity, and abdominal surgery history. D2 lymph node dissection was more frequently performed in the intracorporeal group because of the presence of more advanced cancer stages. The overall morbidity in the intracorporeal and extracorporeal group was 23.7% and 27.7%, respectively (p = 0.405). However, the intracorporeal group showed a significantly lower incidence of late complications (0.8% vs. 7.5%, p = 0.008). Concerning complications, the incidence of anastomotic bleeding (0% vs. 5.5%, p = 0.008) and anastomotic stenosis (0% vs. 4.5%, p = 0.024) was significantly lower in the intracorporeal group. In univariate and multivariate analyses, American Society of Anesthesiologists score and operative bleeding were independent predictive factors for postoperative complications in patients who underwent intracorporeal anastomosis. CONCLUSIONS Intracorporeal anastomosis using linear staplers reduced anastomotic bleeding and stenosis compared to extracorporeal anastomosis after LTG. Future research will be required to determine the ideal method for intracorporeal anastomosis in LTG.

中文翻译：

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在胃癌的腹腔镜全胃切除术中使用内窥镜线性吻合器（重叠法）减少了体内食管空肠吻合术的吻合并发症。

背景技术随着外科技术和仪器的进步，用于腹腔镜全胃切除术（LTG）的体内吻合越来越多。然而，尽管在许多研究中已经证明了其技术可行性，但体内吻合术在减少术后并发症方面的益处尚未得到证实。在这项研究中，我们调查了体内吻合术对减少LTG术后并发症的影响。方法我们分析了2008年至2018年间连续接受LTG的410例胃癌患者，其中118例采用线性吻合器（重叠法）进行了体内吻合，而292例采用了圆形吻合器进行了体外吻合。比较了两组的短期手术结局，包括术后并发症。结果两组在年龄，性别，合并症和腹部手术史上均无显着差异。由于存在更晚期的癌症，在体内组中更经常进行D2淋巴结清扫术。体内和体外组的总发病率分别为23.7％和27.7％（p = 0.405）。然而，体内组显示晚期并发症的发生率显着降低（0.8％比7.5％，p = 0.008）。关于并发症，体内组的吻合口出血发生率（0％vs. 5.5％，p = 0.008）和吻合口狭窄（0％vs. 4.5％，p = 0.024）显着降低。在单变量和多变量分析中，美国麻醉医师学会评分和手术出血是接受体内吻合术的患者术后并发症的独立预测因素。结论与LTG术后体外吻合相比，使用线性吻合器进行体内吻合减少了吻合口出血和狭窄。需要进一步的研究来确定LTG体内吻合的理想方法。