1. Equal short-term outcomes of intracorporeal mechanical gastrogastrostomy in laparoscopic pylorus-preserving gastrectomy for cT1N0 gastric cancer in the middle stomach compared with the extracorporeal hand-sewing method.
- Author
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Harada, Hiroki, Eto, Kojiro, Ohashi, Manabu, Kurihara, Nozomi, Ri, Motonari, Makuuchi, Rie, Ida, Satoshi, Hayami, Masaru, Kumagai, Koshi, Sano, Takeshi, and Nunobe, Souya
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GASTRECTOMY , *LAPAROSCOPY , *STOMACH tumors , *PATIENT safety , *T-test (Statistics) , *STAPLERS (Surgery) , *PROBABILITY theory , *LOGISTIC regression analysis , *PYLORUS , *TREATMENT effectiveness , *RETROSPECTIVE studies , *MULTIVARIATE analysis , *WOUND infections , *MANN Whitney U Test , *CHI-squared test , *DESCRIPTIVE statistics , *ODDS ratio , *SURGICAL complications , *GASTROSTOMY , *STATISTICS , *TUMOR classification , *CONFIDENCE intervals , *COMPARATIVE studies , *DATA analysis software , *DISEASE incidence , *DISEASE risk factors - Abstract
Background: Intracorporeal mechanical gastrogastrostomy (IMG) techniques have recently been developed and their short-term safety was presented in their initial evaluation. However, whether they are comparable to extracorporeal hand-sewing gastrogastrostomy (EHG) remains unclear. The aim of the study is to establish the safety of IMG in totally laparoscopic pylorus-preserving gastrectomy (TLPPG) compared to EHG in laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). Methods: We retrospectively analyzed the short-term outcomes of patients with middle-third early gastric cancer who underwent LAPPG or TLPPG between 2005 and 2022. The primary objective of this study was to evaluate the non-inferiority of IMG to EHG in terms of safety, with the primary endpoint being the risk difference in anastomosis-related complications (ARCs). The sample size required to achieve a statistical power of 80% for the non-inferiority test was 971 with a one-sided alpha level of 5% and non-inferiority of 5%. Results: The analysis included a total of 1,021 patients who underwent LAPPG or TLPPG during the study period. Among them, 488 patients underwent EHG, while 533 underwent IMG. The incidences of ARCs were 11.3% and 11.4% in EHG and IMG, respectively. The observed difference in incidence was 0.0017 (90% confidence interval − 0.0313 to 0.0345), which statistically demonstrated the non-inferiority of IMG to EHG in the incidence of ARCs. Among other complications, the incidence of wound infection in IMG was lower than that in EHG. Conclusion: IMG is safe regarding ARCs compared with EHG. These results will encourage surgeons to introduce IMG for patients with early middle gastric cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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