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

Background: Intracorporeal esophagojejunostomy remains a technically challenging step in totally laparoscopic total gastrectomy (TLTG), and long-term outcome data for modified linear-stapled techniques are limited. Methods: We conducted an observational study including 167 consecutive patients who underwent TLTG with D2 lymphadenectomy and intracorporeal T-shaped functional end-to-end esophagojejunostomy between July 2017 and July 2025. Perioperative outcomes, postoperative complications, and long-term oncologic outcomes were analyzed. Results: All procedures were completed laparoscopically without conversion to open surgery. No anastomotic leakage occurred. Overall postoperative morbidity was 2.4%, and no postoperative mortality was observed. The mean follow-up duration was 44.1 ± 20.0 months, with complete survival follow-up. The 5-year overall survival rate was 41.8%. Conclusions: T-shaped functional end-to-end esophagojejunostomy after TLTG is safe and reproducible, with low anastomotic-related morbidity and acceptable long-term oncologic outcomes. These findings provide real-world evidence supporting standardized intracorporeal reconstruction following total gastrectomy.