J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 5, May 2026, pages 336-342

Perioperative and Long-Term Outcomes of T-Shaped Esophagojejunostomy After Laparoscopic Total Gastrectomy for Gastric Cancer

↓ Figure 1. Intracorporeal T-shaped functional end-to-end esophagojejunostomy. (a, b) Creation of the initial side-to-side esophagojejunostomy. Small enterotomies are made on the lateral wall of the esophagus (E) and the antimesenteric border of the jejunum (J), followed by insertion and firing of a linear stapler (S) to create a functional side-to-side anastomosis (arrow). (c, d) Perpendicular stapling step. A second linear stapler is applied perpendicular to the initial staple line, incorporating both the esophageal and jejunal walls at the level of the common entry hole. Upon firing, this step closes the common entry hole and trims the overlapping tissue edges rather than resecting the anastomosis. (e, f) Final configuration of the T-shaped functional end-to-end esophagojejunostomy. The intersection of the two staple lines creates a characteristic T-shaped geometry (arrow), resulting in a straight luminal alignment without a residual blind pouch or jejunal stump. The apparent stump-like structure corresponds to the transverse staple line rather than a true jejunal stump. E: esophagus; J: jejunum; S: stapler.

↓ Figure 2. Postoperative contrast study. Contrast study shows a smooth and continuous luminal passage from the esophagus (E) to the jejunum (J), without evidence of a blind pouch or diverticular formation. The arrow indicates the anastomotic site.

↓ **Table 1.** Baseline Characteristics of the Study Population (N = 167)
Age (years)	60.97 ± 12.05 (range: 26–88)
Values are presented as mean ± standard deviation or n (%), unless otherwise indicated. Pathological stage was defined according to the Japanese Gastric Cancer Association (JGCA) Classification, Fifth Edition. ASA: American Society of Anesthesiologists physical status classification.
BMI (kg/m²)	18.07 ± 6.40
Sex
Male	118 (70.7%)
Female	49 (29.3%)
ASA physical status
I	71 (42.5%)
II	73 (43.7%)
III	23 (13.8%)
Tumor location
Upper third	20 (12.0%)
Middle third	141 (84.4%)
Diffuse infiltrative	6 (3.6%)
Histological type
Tubular or papillary adenocarcinoma	99 (59.3%)
Mucinous adenocarcinoma	36 (21.5%)
Signet-ring cell carcinoma	32 (19.2%)
Histological differentiation
Well differentiated	38 (22.8%)
Moderately differentiated	51 (30.5%)
Poorly/undifferentiated	78 (46.7%)
Pathological stage (JGCA)
IA	18 (10.8%)
IB	20 (12.0%)
IIA	43 (25.7%)
IIB	33 (19.8%)
IIIA	14 (8.4%)
IIIB	31 (18.6%)
IIIC	8 (4.8%)

↓ Table 1. Baseline Characteristics of the Study Population (N = 167)

Age (years)

60.97 ± 12.05 (range: 26–88)

Values are presented as mean ± standard deviation or n (%), unless otherwise indicated. Pathological stage was defined according to the Japanese Gastric Cancer Association (JGCA) Classification, Fifth Edition. ASA: American Society of Anesthesiologists physical status classification.

BMI (kg/m²)

18.07 ± 6.40

Sex

Male

118 (70.7%)

Female

49 (29.3%)

ASA physical status

71 (42.5%)

73 (43.7%)

III

23 (13.8%)

Tumor location

Upper third

20 (12.0%)

Middle third

141 (84.4%)

Diffuse infiltrative

6 (3.6%)

Histological type

Tubular or papillary adenocarcinoma

99 (59.3%)

Mucinous adenocarcinoma

36 (21.5%)

Signet-ring cell carcinoma

32 (19.2%)

Histological differentiation

Well differentiated

38 (22.8%)

Moderately differentiated

51 (30.5%)

Poorly/undifferentiated

78 (46.7%)

Pathological stage (JGCA)

18 (10.8%)

20 (12.0%)

IIA

43 (25.7%)

IIB

33 (19.8%)

IIIA

14 (8.4%)

IIIB

31 (18.6%)

IIIC

8 (4.8%)

↓ **Table 2.** Operative Outcomes (N = 167)
Technical feasibility
Values are presented as mean ± standard deviation or n (%), unless otherwise indicated. Estimated blood loss was calculated intraoperatively by the anesthesiology team. Technical errors during anastomosis were defined as intraoperative stapler misfiring or need for additional suturing without clinical sequelae. D2 lymphadenectomy was performed according to the Japanese Gastric Cancer Association guidelines.
Estimated blood loss (mL)	34.04 ± 14.30
Conversion to open surgery	0 (0%)
Nasojejunal tube placement	62 (37.2%)
Operative time (min)	207.01 ± 36.0 (range: 120–300)
Oncologic quality
Retrieved lymph nodes (n)	22.95 ± 6.45 (range: 15–45)
Metastatic lymph nodes (n)	2.40 ± 2.75 (range: 0–12)
Proximal resection margin (cm)	5.2 ± 0.9 (range: 2.5–7.0)
Negative proximal and distal margins	167 (100%)
Intraoperative complications
Splenic vessel injury	3 (1.8%)
Splenic parenchymal injury	4 (2.4%)
Hepatic parenchymal injury	3 (1.8%)
Middle colic artery injury	1 (0.6%)
Small bowel serosal injury	1 (0.6%)
Technical errors during anastomosis	3 (1.8%)

↓ Table 2. Operative Outcomes (N = 167)

Technical feasibility

Values are presented as mean ± standard deviation or n (%), unless otherwise indicated. Estimated blood loss was calculated intraoperatively by the anesthesiology team. Technical errors during anastomosis were defined as intraoperative stapler misfiring or need for additional suturing without clinical sequelae. D2 lymphadenectomy was performed according to the Japanese Gastric Cancer Association guidelines.

Estimated blood loss (mL)

34.04 ± 14.30

Conversion to open surgery

0 (0%)

Nasojejunal tube placement

62 (37.2%)

Operative time (min)

207.01 ± 36.0 (range: 120–300)

Oncologic quality

Retrieved lymph nodes (n)

22.95 ± 6.45 (range: 15–45)

Metastatic lymph nodes (n)

2.40 ± 2.75 (range: 0–12)

Proximal resection margin (cm)

5.2 ± 0.9 (range: 2.5–7.0)

Negative proximal and distal margins

167 (100%)

Intraoperative complications

Splenic vessel injury

3 (1.8%)

Splenic parenchymal injury

4 (2.4%)

Hepatic parenchymal injury

3 (1.8%)

Middle colic artery injury

1 (0.6%)

Small bowel serosal injury

1 (0.6%)

Technical errors during anastomosis

3 (1.8%)

↓ **Table 3.** Postoperative and Long-Term Outcomes (N = 167)
Postoperative complications
Values are presented as mean ± standard deviation or n (%), unless otherwise indicated. Postoperative complications were defined as events occurring within 30 days after surgery. Pain intensity was assessed using the visual analog scale (VAS). Overall survival was estimated using the Kaplan–Meier method.
Pneumonia	1 (0.6%)
Residual intra-abdominal abscess	1 (0.6%)
Surgical site infection	2 (1.2%)
Anastomotic leakage	0 (0%)
Postoperative pain (VAS)
Mild	77 (44.5%)
Moderate	72 (41.6%)
Severe	18 (10.4%)
Very severe	0 (0.0%)
Postoperative recovery
Duration of nasojejunal tube placement (h)	92.43 ± 55.6 (range: 24–360)
Time to drain removal (days)	3.7 ± 1.6 (range: 2–7)
Time to first flatus (h)	49.58 ± 16.7 (range: 24–96)
Time to oral intake (days)	3.01 ± 1.09 (range: 2–6)
Postoperative hospital stay (days)	7.45 ± 1.89 (range: 5–15)
Adjuvant chemotherapy
Yes	129 (77.2%)
No	38 (22.8%)
Long-term outcomes
Mean follow-up duration (months)	44.10 ± 20.01 (range: 2–84)
Postoperative reflux symptoms	33 (19.8%)
Anastomotic stricture	3 (1.8%)
Postoperative bowel obstruction	2 (1.8%)
Anastomotic recurrence	1 (0.6%)
Distant metastasis	31 (18.6%)
Time to metastasis (months)	22.5 ± 9.1 (range: 8–52)
Mean overall survival (months)	54.38 ± 1.98 (range: 31.15–56.85)

↓ Table 3. Postoperative and Long-Term Outcomes (N = 167)

Postoperative complications

Values are presented as mean ± standard deviation or n (%), unless otherwise indicated. Postoperative complications were defined as events occurring within 30 days after surgery. Pain intensity was assessed using the visual analog scale (VAS). Overall survival was estimated using the Kaplan–Meier method.

Pneumonia

1 (0.6%)

Residual intra-abdominal abscess

1 (0.6%)

Surgical site infection

2 (1.2%)

Anastomotic leakage

0 (0%)

Postoperative pain (VAS)

Mild

77 (44.5%)

Moderate

72 (41.6%)

Severe

18 (10.4%)

Very severe

0 (0.0%)

Postoperative recovery

Duration of nasojejunal tube placement (h)

92.43 ± 55.6 (range: 24–360)

Time to drain removal (days)

3.7 ± 1.6 (range: 2–7)

Time to first flatus (h)

49.58 ± 16.7 (range: 24–96)

Time to oral intake (days)

3.01 ± 1.09 (range: 2–6)

Postoperative hospital stay (days)

7.45 ± 1.89 (range: 5–15)

Adjuvant chemotherapy

Yes

129 (77.2%)

38 (22.8%)

Long-term outcomes

Mean follow-up duration (months)

44.10 ± 20.01 (range: 2–84)

Postoperative reflux symptoms

33 (19.8%)

Anastomotic stricture

3 (1.8%)

Postoperative bowel obstruction

2 (1.8%)

Anastomotic recurrence

1 (0.6%)

Distant metastasis

31 (18.6%)

Time to metastasis (months)

22.5 ± 9.1 (range: 8–52)

Mean overall survival (months)

54.38 ± 1.98 (range: 31.15–56.85)