J Gastric Cancer.  2020 Mar;20(1):81-94. 10.5230/jgc.2020.20.e4.

Risk Factors for Duodenal Stump Leakage after Laparoscopic Gastrectomy for Gastric Cancer

Affiliations
  • 1Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China. chenpinghwamei@163.com
  • 2Department of Clinical Medicine, Medical College of Ningbo University, Ningbo, China.
  • 3Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
  • 4Department of Clinical Medicine, Monash University School of Medicine, Nursing and Health Sciences, Melbourne, Australia.

Abstract

PURPOSE
Duodenal stump leakage (DSL) is a potentially fatal complication that can occur after gastrectomy, but its underlying risk factors are unclear. This study aimed to investigate the risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer (GC).
MATERIALS AND METHODS
Relevant data were collected from several prospective databases to retrospectively analyze the data of GC patients who underwent Billroth II (B-II) or Roux-en-Y (R-Y) reconstruction after laparoscopic gastrectomy from 2 institutions (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences). The DSL risk factors were analyzed using univariate and multivariate analysis regression.
RESULTS
A total of 810 patients were eligible for our analysis (426 with R-Y, 384 with B-II with Braun). Eleven patients had DSL (1.36%). Body mass index (BMI), elevated preoperative C-reactive protein (CRP) level, and unreinforced duodenal stump were the independent risk factors for DSL. DSL was diagnosed in 2-12 days, with a median of 8 days. Seven patients received conservative treatment, 3 patients received puncture treatment, and only 1 patient required reoperation. All patients recovered successfully after treatment.
CONCLUSIONS
The risk factors of DSL were BMI ≥24 kg/m², elevated preoperative CRP level, and unreinforced duodenal stump. Nonsurgical treatments for DSL are preferred.

Keyword

Risk factors; Duodenal stump leakage; Laparoscopic gastrectomy; Gastric cancer

MeSH Terms

Asian Continental Ancestry Group
Body Mass Index
C-Reactive Protein
Gastrectomy*
Gastroenterostomy
Humans
Multivariate Analysis
Prospective Studies
Punctures
Reoperation
Retrospective Studies
Risk Factors*
Stomach Neoplasms*
C-Reactive Protein
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