T-shaped functional end-to-end anastomosis as an alternative method for esophagojejunostomy after totally laparoscopic total gastrectomy for gastric cancer.

[BACKGROUND] Functional end-to-end anastomosis (FEEA) and the overlap methods for reconstruction after totally laparoscopic total gastrectomy (TLTG) pose technical challenges. We developed a modified T-shaped FEEA to facilitate the procedure. This study aimed to evaluate the short- and long-term outcomes of the modified T-shaped FEEA compared to the overlap method following TLTG for gastric cancer (GC).

[METHOD] This cohort study enrolled 114 patients with middle- or upper-third GC who underwent TLTG with linear stapler for reconstruction between August 2015 and October 2020. Outcomes analyzed included operative characteristics, postoperative complications, one-year nutritional status, and long-term survival. Propensity score-matched (PSM) was applied to adjust for baseline differences between groups.

[RESULTS] After PSM, 27 patients were included in each group. No significant differences were found between the two groups in terms of early surgical outcomes, including operating time, time of first flatus, overall morbidities and mortality, and postoperative hospital stays. However, the modified T-shaped FEEA group had a significantly shorter anastomosis time (37.2 vs. 50.7 min,  = 0.005). Changes in body weight, hemoglobin, and albumin levels one-year postoperatively were comparable. Similarly, there was no significant difference in five-year overall survival and disease-free survival between the two groups (60% vs. 53% and 49% vs. 40%, respectively).

[CONCLUSIONS] The modified T-shaped FEEA method offers a viable alternative to the overlap method for reconstruction after TLTG for GC, with shorter anastomosis time and comparable surgical and long-term outcomes.