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

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 longterm 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.(International