{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T10:06:58Z","timestamp":1766138818659,"version":"3.40.4"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T00:00:00Z","timestamp":1722816000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n            <jats:title>Objective\/Background:<\/jats:title>\n            <jats:p>Various 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017\u20132021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Three 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In 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\u2019s preference.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/sla.0000000000006470","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T09:00:28Z","timestamp":1722848428000},"page":"788-798","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer"],"prefix":"10.1097","volume":"280","author":[{"given":"Marcel Andr\u00e9","family":"Schneider","sequence":"first","affiliation":[{"name":"Department of Surgery and Transplantation, University Hospital Z\u00fcrich, Zurich, Switzerland"}]},{"given":"Jeesun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Hospital, Seoul, South Korea"}]},{"given":"Felix","family":"Berlth","sequence":"additional","affiliation":[{"name":"Department of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Mainz, Germany"},{"name":"Department of Surgery, University Hospital Tuebingen, Tuebingen, Germany"}]},{"given":"Yutaka","family":"Sugita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan"}]},{"given":"Peter P.","family":"Grimminger","sequence":"additional","affiliation":[{"name":"Department of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Mainz, Germany"}]},{"given":"Bas P.L.","family":"Wijnhoven","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands"}]},{"given":"Hidde","family":"Overtoom","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands"}]},{"given":"Ines","family":"Gockel","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany"}]},{"given":"Ren\u00e9","family":"Thieme","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany"}]},{"given":"Ewen A.","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}]},{"given":"William","family":"Butterworth","sequence":"additional","affiliation":[{"name":"Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}]},{"given":"Henrik","family":"Nienh\u00fcser","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany"}]},{"given":"Beat","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany"}]},{"given":"Nerma","family":"Crnovrsanin","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany"}]},{"given":"Daniel","family":"Gero","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, University Hospital Z\u00fcrich, Zurich, Switzerland"}]},{"given":"Felix","family":"Nickel","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}]},{"given":"Suzanne","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands"}]},{"given":"Mark I.","family":"van Berge Henegouwen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands"}]},{"given":"Philip H.","family":"Pucher","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands"}]},{"given":"Kashuf","family":"Khan","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands"}]},{"given":"Asif","family":"Chaudry","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK"}]},{"given":"Pranav H.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK"}]},{"given":"Manuel","family":"Pera","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK"}]},{"given":"Mariagiulia","family":"Dal Cero","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK"}]},{"given":"Carlos","family":"Garcia","sequence":"additional","affiliation":[{"name":"Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}]},{"given":"Guillermo","family":"Martinez Salinas","sequence":"additional","affiliation":[{"name":"Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}]},{"given":"Paulo","family":"Kassab","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital San Borja Arriar\u00e1n, Santiago, Regi\u00f3n Metropolitana, Chile"}]},{"given":"Osvaldo Ant\u00f4nio","family":"Prado Castro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital San Borja Arriar\u00e1n, Santiago, Regi\u00f3n Metropolitana, Chile"}]},{"given":"Enrique","family":"Norero","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gastroesophageal and Bariatric Surgical Division, Santa Casa of S\u00e3o Paulo Medical School and Hospital, S\u00e3o Paulo, Brazil"}]},{"given":"Paul","family":"Wisniowski","sequence":"additional","affiliation":[{"name":"Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr Sotero del Rio, Pontificia Universidad Catolica de Chile, Santiago, Chile"}]},{"given":"Luke Randall","family":"Putnam","sequence":"additional","affiliation":[{"name":"Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr Sotero del Rio, Pontificia Universidad Catolica de Chile, Santiago, Chile"}]},{"given":"Pietro Maria","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Division of Upper GI and General Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA"}]},{"given":"Giovanni","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Division of Upper GI and General Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA"}]},{"given":"Rita","family":"Gudaityte","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}]},{"given":"Almantas","family":"Maleckas","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy"}]},{"given":"Leanne","family":"Prodehl","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania"}]},{"given":"Antonio","family":"Castaldi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa"}]},{"given":"Michel","family":"Prudhomme","sequence":"additional","affiliation":[{"name":"Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa"}]},{"given":"Hyuk-Joon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Hospital, Seoul, South Korea"}]},{"given":"Takeshi","family":"Sano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan"}]},{"given":"Gian Luca","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"Department of Digestive Surgery and Digestive Oncology, Car\u00e9meau University Hospital, N\u00eemes, France"}]},{"given":"Giovanni","family":"De Manzoni","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Brescia, Brescia, Italy"}]},{"given":"Simone","family":"Giacopuzzi","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Brescia, Brescia, Italy"}]},{"given":"Maria","family":"Bencivenga","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Brescia, Brescia, 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