Antecolic vs retrocolic gastrojejunostomy after laparoscopic gastrectomy for cancer. A multicenter propensity matched analysis

Background: Intracorporeal Roux-en-Y reconstruction has been shown to be the most effective reconstruction method after minimally invasive distal gastrectomy. The aim of this study is to compare postoperative complications and early outcomes after antecolic and retrocolic gastro-jejunal anastomoses reconstructions. Methods: A multicentric retrospective cohort study was designed to compare only laparoscopic Roux-en-Y procedures with intracorporeal antecolic and retrocolic reconstruction of gastro-jejunal anastomoses performed on posterior wall of the stomach from January 2009 to December 2019. After performing propensity score matching analysis (PSM), data from 258 patients were analysed. Intraoperative data included fashion of gastro-jejunal anastomosis; length and type of cartridge used; total operative time. To evaluate safety and efficacy of anastomoses, early postoperative complications and recovery outcomes were examined. Results: Operative time was statistically significant lower for the antecolic group (192,88 ± 42,60 min vs. 227,09 ± 81,26 min; p < 0,001). No differences between the two groups were identified in the incidence of postoperative complications neither in recovery outcomes. Conclusions: Both antecolic and retrocolic techniques are reliable and effective to perform, since the route of the alimentary limb does not affect the incidence of postoperative complications and gastric emptying function. Considering its safety and efficacy and the shorter operative time, the antecolic approach with a large stapled anastomosis could be recommended.