• Marcel André Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, WijnhovenBas P LBPLDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Hidde Overtoom, Ines Gockel, René Thieme, Ewen A Griffiths, William Butterworth, Henrik Nienhüser, Beat Müller, Nerma Crnovrsanin, Daniel Gero, Felix Nickel, Suzanne Gisbertz, Mark I van Berge Henegouwen, Philip H Pucher, Kashuf Khan, Asif Chaudry, Pranav H Patel, Manuel Pera, Dal CeroMariagiuliaMSection of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Carlos Garcia, Guillermo Martinez Salinas, Paulo Kassab, Osvaldo Antônio Prado Castro, Enrique Norero, Paul Wisniowski, Luke Randall Putnam, Pietro Maria Lombardi, Giovanni Ferrari, Rita Gudaityte, Almantas Maleckas, Leanne Prodehl, Antonio Castaldi, Michel Prudhomme, Hyuk-Joon Lee, Takeshi Sano, Gian Luca Baiocchi, Giovanni De Manzoni, Simone Giacopuzzi, Maria Bencivenga, Riccardo Rosati, Francesco Puccetti, Domenico D'Ugo, Souya Nunobe, Han-Kwang Yang, Christian Alexander Gutschow, and GASTRODATA consortium.
• Department of Surgery & Transplantation, University Hospital Zürich, Raemistrasse 100, 8091 Zurich, Switzerland.
• Ann. Surg. 2024 Aug 5.

Objective/BackgroundVarious 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.MethodsMiTG and miDG patients were selected from 9356 oncological gastrectomies performed 2017-2021 in 44 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.ResultsThree major anastomotic techniques (circular stapled (CS); linear stapled (LS); hand sewn (HS)), and three 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, 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%, HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as predictive factor for AL, overall and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, RX 1.2%), overall (BI: 14.5%, BII: 15.0%, RX: 18.7%,) and major morbidity (BI: 7.9%, BII: 9.1%, RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, RY: 1.1%%) were not affected by bowel reconstruction.ConclusionIn 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 surgeon's preference.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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