Quality of life after functional end-to-end vs overlap esophagojejunostomy in totally laparoscopic total gastrectomy

BACKGROUND Totally laparoscopic total gastrectomy (TLTG) offers several benefits, but esophagojejunostomy remains technically challenging.Circular stapling has limitations, whereas linear staplers offer simpler alternatives, such as functional end-to-end (FETE) and overlap anastomoses.However, prospective evidence comparing their effects on postoperative quality of life (QoL) is limited.We hypothesized that FETE and overlap anastomoses using the self-pulling and latter transected technique (SPLT) would be noninferior with respect to 12-month global health status (GHS).AIM To compare postoperative QoL between FETE-SPLT and overlap-SPLT following TLTG.METHODS This single-center, prospective, randomized, open-label, non-inferiority trial enrolled 96 patients with gastric cancer undergoing TLTG.Patients were randomly assigned to FETE-SPLT or overlap-SPLT (n = 48 per group).The primary endpoint was the change from baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 GHS at 12 months, with a non-inferiority margin of -4 points and a minimal clinically important difference of ± 10 points.Missing data were handled using multiple imputation, and linear mixed-effects models were used to analyze repeated measures. RESULTSOf the 96 randomized patients (mean age: 62.5 years; 77.1% male), 7 were excluded intraoperatively because TLTG could not be completed, and 89 received the assigned intervention.The primary intention-to-treat analysis included all 96 randomized patients, technique (SPLT), in totally laparoscopic total gastrectomy demonstrates that FETE-SPLT is non-inferior to overlap-SPLT with respect to 12-month global health status, with the confidence interval falling within the predefined minimal clinically important difference range.No statistically significant between-group differences were observed in quality-oflife recovery or safety outcomes, but FETE-SPLT required a shorter anastomotic time and fewer stapler cartridges, suggesting an advantage in surgical efficiency.