Evaluation of Long-Term Outcomes After Total Gastrectomy for Gastric Cancer: A Comparative Analysis of Hand-Sewn Versus Mechanical Esophagojejunostomy

ORIGINAL ARTICLE
Evgeny A. Тoneev, Nikita A. Berestov, Danil D. Prokhorov, Maria A. Sypalo, Polina A. Nevedomskaia, Adel F. Rysaev, Eleonora A. Mitina

 
For citation: Тoneev EA, Berestov NA, Prokhorov DD, Sypalo MA, Nevedomskaia PA, Rysaev AF, Mitina EA. Evaluation of Long-Term Outcomes After Total Gastrectomy for Gastric Cancer: A Comparative Analysis of Hand-Sewn Versus Mechanical Esophagojejunostomy. International Journal of Biomedicine. 2026;16(1):41-45. doi:10.21103/Article16(1)_OA4
 
Originally published March 5, 2026

Abstract: 

Background: Total gastrectomy remains a key component of gastric cancer treatment, and the method used to construct the esophagojejunostomy may influence long-term functional outcomes and quality of life. Evidence comparing hand-sewn and mechanical anastomoses in this context remains inconsistent. This retrospective study aimed to evaluate and compare long-term functional outcomes and quality of life in patients undergoing total gastrectomy with either hand-sewn or mechanical esophagojejunostomy.
Methods and Results: The study included 153 patients who underwent total gastrectomy for histologically confirmed gastric adenocarcinoma. Patients were divided into two groups based on the anastomotic technique: mechanical circular stapler or hand-sewn anastomosis (according to a patented method). Long-term outcomes were evaluated 12 months postoperatively using EORTC QLQ-C30 and QLQ-STO22 questionnaires, along with endoscopic assessment of reflux esophagitis using the Los Angeles classification. Postoperative complications were graded according to the Clavien–Dindo classification.
Both groups demonstrated comparable short-term postoperative outcomes and similar complication rates according to the Clavien–Dindo classification. However, patients with a hand-sewn anastomosis showed significantly better long-term quality-of-life scores (EORTC QLQ-C30, QLQ-STO22), including higher functional domain scores and lower scores for reflux, pain, nausea, and dietary restriction. Endoscopic assessment revealed no significant differences in esophagitis prevalence or severity between groups.
Conclusion: While mechanical anastomosis offers advantages in operative duration and blood loss, the hand-sewn technique provides superior long-term functional outcomes and quality-of-life benefits. These findings support the consideration of hand-sewn esophagojejunostomy in clinical settings where long-term recovery and patient-reported outcomes are prioritized.

Keywords: 
gastrectomy • quality of life • esophagojejunostomy • hand-sewn anastomosis • mechanical anastomosis • complications
References: 
  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. PMID: 33538338.
  2. Lordick F, Carneiro F, Cascinu S, Fleitas T, Haustermans K, Piessen G, Vogel A, Smyth EC; ESMO Guidelines Committee. Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct;33(10):1005-1020. doi: 10.1016/j.annonc.2022.07.004. PMID: 35914639.
  3. Kaprin AD, Starinsky VV, Shakhzadova AO (eds.). Malignant neoplasms in Russia in 2021 (morbidity and mortality). Moscow: Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiology Centre, Ministry of Health of Russia, 2022. [In Russian].
  4. Honório FCC, Tustumi F, Pinheiro Filho JEL, Marques SSB, Glina FPA, Henriques AC, Dias AR, Waisberg J. Esophagojejunostomy after total gastrectomy: A systematic review and meta-analysis comparing hand-sewn and stapled anastomosis. J Surg Oncol. 2022 Jul;126(1):161-167. doi: 10.1002/jso.26909. PMID: 35689590.
  5. Toneev EA, Firsov AA, Martynov AA, Keshyan EA. Patent RU № 2836347. 2025. [In Russian].
  6. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021 Jul;40(7):4745-4761. doi: 10.1016/j.clnu.2021.03.031. PMID: 34242915.
  7. Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Bottino AAG, Fontoura RP, Lopes Filho GJ. Quality of life as a fundamental outcome after curative intent gastrectomy for adenocarcinoma: lessons learned from patients. J Gastrointest Oncol. 2019 Oct;10(5):989–998. doi:10.21037/jgo.2019.06.05. PMID: 31602337.
  8. Zhou ZG, Hu M, Li Y, et al. Stapled vs hand-sewn gastroenteric anastomosis after gastrectomy: randomized controlled trial. World J Gastroenterol. 2003;9(4):772–774.
  9. Degiuli M, Elmore U, De Carli S, et al. Mechanical vs hand-sewn anastomosis after gastrectomy for cancer: a multicenter comparison. World J Surg Oncol. 2014;12:292.
  10. Kvist E, Helminen O, Helmiö M, Huhta H, Jalkanen A, Junttila A, Kallio R, Koivukangas V, Kokkola A, Laine S, Lietzen E, Louhimo J, Meriläinen S, Pohjanen VM, Rantanen T, Ristimäki A, Räsänen JV, Saarnio J, Sihvo E, Toikkanen V, Tyrväinen T, Valtola A, Kauppila JH; FINEGO group. Stapled vs handsewn anastomosis and anastomotic leaks in gastric cancer surgery-a population-based nationwide study in Finland. J Gastrointest Surg. 2024 Jun;28(6):820-823. doi: 10.1016/j.gassur.2024.03.005. PMID: 38599994.
  11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.
  12. Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, et al. Short-term surgical outcomes from the nationwide registry of the Japanese Gastric Cancer Association. Gastric Cancer. 2018;21(4):665–674.
  13. Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Mortality and morbidity after D2 gastrectomy for gastric cancer: an analysis of 2,500 patients. Br J Surg. 2004;91(8):1099–1104.
  14. Toneev EA, Firstov AA, Keshyan EA, Pikin OV, Danilova LA, Martynov AA, Zhinov AV. Immediate surgical results of gastrectomies for gastric cancer: Experience of the regional oncology center. Novosti Khirurgii [News of Surgery]. 2023;31(6):502–512. [In Russian].
  15. Uprak TK, Ekdal DC, Ergenç M, Attaallah W, et al. “Hand-sewn versus Stapled Anastomosis for Billroth II Gastrojejunostomy After Distal Gastrectomy: Comparison of Short-term Outcomes.” İstanbul Med J. 2023;24(2):181-185.
  16. van Amelsfoort RM, van der Sluis K, Schats W, Jansen EPM, van Sandick JW, Verheij M, Walraven I. Health-Related Quality of Life in Locally Advanced Gastric Cancer: A Systematic Review. Cancers (Basel). 2021 Nov 25;13(23):5934. doi: 10.3390/cancers13235934. PMID: 34885043; PMCID: PMC8657098.
  17. Yang K, Zhang WH, Liu K, Chen XZ, Zhou ZG, Hu JK. Comparison of quality of life between Billroth-І and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: A randomized controlled trial. Sci Rep. 2017 Sep 12;7(1):11245. doi: 10.1038/s41598-017-09676-2. Erratum in: Sci Rep. 2018 Apr 25;8(1):6783. doi: 10.1038/s41598-018-24612-8. PMID: 28900096; PMCID: PMC5595810.
  18. Park KB, Park JY, Lee SS, Chung HY, Kwon OK. Chronological changes in quality of life and body composition after gastrectomy for locally advanced gastric cancer. Ann Surg Treat Res. 2020 May;98(5):262-269. doi: 10.4174/astr.2020.98.5.262. Epub 2020 Apr 28. PMID: 32411631; PMCID: PMC7200603.
  19. Ito Y, Yoshikawa T, Fujiwara M, Kojima H, Matsui T, Mochizuki Y, Cho H, Aoyama T, Ito S, Misawa K, Nakayama H, Morioka Y, Ishiyama A, Tanaka C, Morita S, Sakamoto J, Kodera Y. Quality of life and nutritional consequences after aboral pouch reconstruction following total gastrectomy for gastric cancer: randomized controlled trial CCG1101. Gastric Cancer. 2016 Jul;19(3):977-85. doi: 10.1007/s10120-015-0529-5. Epub 2015 Aug 14. PMID: 26272278.
  20. Im MH, Kim DY, Kim YJ, Kim SH, Kim CW, Choi SH, et al. The impact of esophageal reflux-induced symptoms on quality of life after gastrectomy for gastric cancer. J Gastric Cancer. 2014;14(3):207–214. doi:10.5230/jgc.2014.14.3.207. PMID: 25364383; PMCID: PMC3996245.
  21. Park SH, Man Yoon H, Ryu KW, Kim YW, Han M, Eom BW. Long-term Functional and Patient-reported Outcomes Between Intra-corporeal Delta-shaped Gastroduodenostomy and Gastrojejunostomy After Laparoscopic Distal Gastrectomy. J Gastric Cancer. 2023 Oct;23(4):561-573. doi: 10.5230/jgc.2023.23.e35. PMID: 37932223; PMCID: PMC10630562.
  22. Maev IV, Andreev DN, Kucheryavy YuA. Gastroesophageal reflux disease: current concepts of pathogenesis, diagnosis, and treatment. Lechashchiy Vrach (The Attending Physician). 2004;(4):12–17. [In Russian].
  23. Solovyova GA, Ilchenko AA, Filippov YuV, Andreev DN. Development and validation of the Russian version of the GERD-HRQL questionnaire for assessing quality of life in patients with gastroesophageal reflux disease. Kachestvennaya Klinicheskaya Praktika (Quality Clinical Practice). 2020;(2):45–51. [In Russian].
  24. Sheptulin AA, Storonova OA, Rumyantseva SA. Classifications of reflux esophagitis and their clinical significance. Endoskopicheskaya Praktika (Endoscopic Practice). 2015;(2):34–39. [In Russian].

Download Article
Received January 26, 2026.
Accepted March 1, 2026.
©2026 International Medical Research and Development Corporation.