Safety and Efficacy of OGT Method Versus the Traditional Overlap Method
Condition: Gastric Cancer
MeSH terms: Stomach Neoplasms
Study type: Observational

Summary: 
      Introduction: The safety and efficiency of OGT-assisted method have not yet been compared
      with conventional overlap approach.

      Methods Retrospectively analyses the data of 155 gastric/gastroesophageal junction (G/GEJ)
      cancer patients who underwent laparoscopic total gastrectomy by conventional(conventional
      group, n=83) or OGT-assisted (OGT group, n=72) overlap methods at Nanfang Hospital. The
      anastomotic efficiency and surgical outcomes were compared between two groups.
    

Detailed description: 
      Although our previous multicenter randomized controlled trial (CLASS-01) has confirmed the
      safety and efficacy of laparoscopic distal gastrectomy for gastric cancer[1, 2], the
      feasibility of laparoscopic total gastrectomy (LTG) remains uncertain. The most challenging
      technical difficulty of LTG is esophagojejunostomy(ESJ)[3, 4]. At present, there is still no
      consensus on the ideal anastomosis method for EJ.

      Since overlap esophagojejunostomy was first proposed in 2010[5], it has gradually gone
      mainstream because of its lower incidence of anastomotic-related complications and
      satisfactory short-term outcomes[6-10]. However, the overlap approach is
      technically-difficult and time-consuming, and might confront intraoperative construction
      complications, such as injuring esophagus caused by the repetition of inserting anvil fork
      into esophagus or developing esophageal submucosa pseudocanals(video 1 and 2). Therefore, we
      first designed an overlap guiding tube (OGT)-assisted method to overcame above
      limitations[11]. And the first reported about the application of OGT-assisted method
      preliminarily indicated that it is safe and feasible, with a satisfactory success rate of
      inserting anvil fork into esophageal lumen at first attempt and esophagojejunostomy time[11].
      However, the safety and efficiency of OGT-assisted method have not yet been compared
      side-by-side with the conventional overlap approach. Therefore, this study aimed to compare
      the OGT-assisted and conventional overlap methods in terms of feasibility and safety in LTG
      for gastric/gastroesophageal junction (G/GEJ) tumors.

      Methods Patients One hundred and fifty-five patients with G/GEJ cancer undergoing LTG via
      either the conventional overlap esophagojejunostomy(conventional group) or OGT-assisted
      overlap esophagojejunostomy (OGT group) in the Department of Gastrointestinal Surgery,
      Southern Medical University Nanfang Hospital, between June 2018 and February 2022 were
      initially eligible for the study. The inclusion criteria were as follows: (1)gastric cancer
      was confirmed by pathological examination; (2) tumor located in GEJ with involving esophagus
      no more than 2cm or the upper, upper to the middle, or entire stomach; (3) had no obvious
      operative contraindication; and (4) aged 18-85 years. The pathological staging was based on
      the TNM system of the 8th edition of the International Federation for the prevention and
      treatment of cancer[12]. This study meets the requirements of the Helsinki Declaration
      revised in 2013. Patients and their families signed informed consent forms before operation.
      This study followed the Strengthening the Reporting of Observational Studies in Epidemiology
      (STROBE) reporting guideline. The data collection protocol was approved by the Ethics
      Committee of Nanfang Hospital, Southern Medical University. Written informed consent was
      obtained from all the patients in the study.
    

Intervention name(s): The overlap guiding tube(OGT) method; The conventional overlap method
Intervention type(s): Procedure; Procedure
Intervention description(s): The overlap guiding tube(OGT) is used to assist the anvil fork placed into the esophageal cavity.; After firing the stapler, two openings were converted into a single entry hole to create an end-to-side esophagojejunostomy, and the entry hole was closed with full-thickness running suture using barbed sutures intracorporeally.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        All patients enrolled in our study underwent standard LTG with D2 lymphadenectomy according
        to the Japanese Gastric Cancer Association treatment guidelines
      
Keywords: Gastric/gastroesophageal junction (G/GEJ) tumors; Laparoscopy total gastrectomy; Overlap esophagojejunostomy; OGT