Objective To investigate the clinical value of esophageal‑jejunal OrVil^TM anas-tomosis and Overlap anastomosis in laparoscopic radical total gastrectomy of adenocarcinoma of esophagogastric junction (AEG).

Methods The retrospective cohort study was conducted. The clinicopathological data of 112 patients with AEG who were admitted to the First Hospital of Jilin University from July 2017 to August 2022 were collected. There were 87 males and 25 females, aged (64±8)years. All 112 patients underwent laparoscopic total gastrectomy and D₂ lymphadenectomy, in which 61 cases with esophageal‑jejunal OrVil^TM anastomosis were divided into the OrVil^TM group, 51 cases with esophageal‑jejunal Overlap anastomosis were divided into the Overlap group. Observa-tion indicators: (1) surgical situations; (2) postoperative complications; (3) influencing factors for patients undergoing esophageal-jejunal OrVil^TM anastomosis. Measurement data with normal distri-bution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(Q₁,Q₃), and comparison between groups was conducted using the non‑parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi‑square test or Fisher exact probability. Logistic regression model was used for multivariate analysis.

Results (1) Surgical situations. The esophageal invasion length and tumor diameter was 1.0(0.7,2.0)cm and (6.3±2.7)cm in patients of the OrVil^TM group, versus 0.2(0.1,0.5)cm and (4.7±2.2)cm, respectively, in patients of the Overlap group, showing significant differences in the above indicators between the two groups (Z=‒6.14, t=3.26, P<0.05). (2) Postoperative complications. Cases with complications ≥Ⅲa grade of Clavien⁃Dindo classification, cases with respiratory system complications, cases with hydrothorax were 13, 17, 13 in the OrVil^TM group, versus 4, 5, 4 in the Overlap group, showing significant differences in the above indicators between the two groups (χ²=3.91, 5.74, 3.91, P<0.05). Cases underwent readmission within postoperative 30 days were 3 and 1 in the OrVil^TM group and the Overlap group, respectively, and all patients recovered after symptomatic treatment. There were 2 cases died after operation in the OrVil^TM group and none of patients died after operation in the Overlap group. (3) Influencing factors for patients undergoing esophageal‑jejunal OrVil^TM anastomosis. Results of multivariate analysis showed that esophageal invasion length was an independent factor influencing for patients undergoing esophageal‑jejunal OrVil^TM anastomosis (odds ratio=8.25, 95% confidence interval as 3.41‒19.96, P<0.05).

Conclusions Compared with esophageal-jejunal Overlap anastomosis, choosing the esophageal-jejunal Orvil^TM anastomosis during laparoscopic radical total gastrectomy can take benefit to the proximal margin of patients with AEG. However, the ratios of complications ≥ Ⅲa grade of Clavien-Dindo classification, respiratory system complications and hydrothorax associated to OrVil^TM anastomosis are relatively increased. Esophageal invasion length is an independent influencing factor for patients undergoing esophageal‑jejunal OrVil^TM anastomosis.