• 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 CeroMariagiuliaMGastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK., 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 and Transplantation, University Hospital Zürich, Zurich, Switzerland.
• Ann. Surg. 2024 Nov 1; 280 (5): 788798788-798.

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 in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.ResultsThree 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.ConclusionsIn 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.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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