Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer

Introduction: Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients. Methods: A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil™) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded. Results: Overall, DST was performed in 60 patients [total gastrectomy (81.7 %, n = 49/60), proximal gastrectomy (10.0 %, n = 6/60), and completion gastrectomy (8.3 %, n = 5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0 %), and 6 patients (10.0 %) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7 %, n = 31/60), laparoscopic (43.3 %, n = 26/60), or robotic (5.0 %, n = 3/60). Anastomotic leak occurred in 6.7 % (n = 4/60), while stricture independent of leak was identified in 19.0 % (n = 11/58) of patients. Complications occurred in 38.3 % (n = 23/60) of patients, of which 52 % were classified as Clavien-Dindo grades III–V complications. Conclusion: In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.