The Efficacy of Minimally Invasive Total Gastrectomy and Side to Side Esophago- Jejunal Anastomosis in Proper Clinico-Pathological Assessment of Gastric Cancer After Neoadjuvant Chemotherapy

Abstract

Background: Minimally invasive total gastrectomy (MITG) for gastric cancer (GC) has been shown to have many merits, such as smaller wounds, a larger workspace, and no limitation due to the patient’s body size. More and more surgeons now prefer MITG as an appropriate method for upper body gastric cancer, or even adenocarcinoma of the esophagogastric junction (AEG), despite the high demand the procedure places on a surgeon’s operating skills.
Esophagojejunostomy after MITG is technically challenging. Failure of the esophago-jejunal anastomosis can lead to significant morbidity, leading to short and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial.
Neoadjuvant chemotherapy is an important part of the comprehensive treatment of advanced gastric cancer (GC). The effect of neoadjuvant chemotherapy plays a key role in the prognosis of GC patients. Pathological response can represent the effect of neoadjuvant chemotherapy.
Objectives: The aim of the present study was to assess the adequacy of minimally invasive total gastrectomy in achieving proper oncological resection and post-operative pathological data retrieval in patients with gastric adenocarcinoma who have received neoadjuvant chemotherapy.
Patients and methods: Twenty patients with gastric cancer who underwent minimally invasive total gastrectomy at the National Cancer Institute - Cairo University were involved in this study between January 2022 and January 2024.
All patients had side-to-side esophagojejunostomy (EJS) using linear stapler.
Results: Eighteen patients (90.0%) have undergone D2 Total gastrectomy, two with extended resection either Splenectomy + Distal Pancreatectomy or only Splenectomy. The mean operative time was 344.75 minutes, the average time of esophago-jejunal anastomosis was 51.50 minutes, and the
average hospital stay was 10.80 days. The average number of retrieved LNs (whether
involved or not) in surgical specimens was 27.35 ± 11.92 ranging from 15.00 to 67.00 LNs. Importantly,
all cases demonstrated clear resection margins, emphasizing the oncological adequacy of MITG with proper
D2 LN dissection.
Conclusion: Our findings support MITG with intra-corporeal side-to-side esophagojejunostomy using linear stapler as a safe and effective surgical approach in gastric cancer management, offering favorable functional and
oncological outcomes and low complication rates