Does Gastro-jejunal anastomosis after Near-Total Gastrectomy with lymphadenectomy for gastric cancer reduce anastomosis fistulas? Randomized trial.

Abstract

Esophagojejunal anastomotic fistulas have long been, and still are, the main obstacle to total gastrectomy.

To reduce their incidence while respecting oncological principles, it became necessary to offer an alternative to total gastrectomy
with esophagojejunal anastomosis.

The primary objective of this study was to demonstrate the superiority of gastrojejunal anastomosis after total gastrectomy with appropriate lymphadenectomy, compared to esophagojejunal anastomosis after total gastrectomy, in terms of anastomotic fistulas, through a randomized trial.

Secondary objectives were the evaluation of oncological resection criteria and quality of life.

This was a randomized trial comparing total gastrectomy with gastrojejunal anastomosis to total gastrectomy with esophagojejunal
anastomosis in patients with gastric cancer.

Randomization was performed via open abdomen.

The occurrence of an anastomotic fistula was systematically monitored from the fifth postoperative day. Diagnosis was based on a
contrast-enhanced abdominal CT scan, allowing classification of anastomotic leaks as grade A radiological leaks and grade B or C clinical leaks.

Our study showed a significant reduction in the rate of anastomotic fistulas in the NTG group compared to the total gastrectomy group (0% versus 11.6%), p=0.02, thus demonstrating the superiority of NTG in preventing anastomotic fistulas.

NTG appears to be an effective, reproducible, and reliable technique, constituting a relevant alternative to total gastrectomy in the management of mid-gastric and distal gastric cancers, while significantly reducing the risk of anastomotic fistulas.