Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Gastric Cancer. 2019 Sep;22(5):1053-1059. doi: 10.1007/s10120-019-00946-8. Epub 2019 Mar 9.
Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer.
This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70).
Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291 min versus 258 min, p < 0.001, LTG; 325 min versus 285 min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management.
Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity.
尽管十二指肠残端漏（DSL）是 Roux-en-Y（R-Y）重建后胃切除术后相对罕见的并发症，但治疗困难且可能致命。我们研究了腹腔镜下 R-Y 重建胃切除术后十二指肠残端加固对 DSL 的影响。
本回顾性研究纳入了 965 例接受腹腔镜远端或全胃切除术（LDG 或 LTG）+R-Y 重建的胃癌患者，比较了两组（十二指肠残端加固组（加固组）（n=895）和未行十二指肠残端加固组（非加固组）（n=70）的手术结果。
与非加固组相比，加固组的手术时间明显更长（LDG：291 分钟与 258 分钟，p<0.001；LTG：325 分钟与 285 分钟，p<0.001）。加固组 DSL 的发生率明显低于非加固组（0.67% vs. 5.71%，p<0.001）。此外，在多因素 logistic 回归分析中，调整潜在混杂因素后，非加固是 DSL 的独立危险因素。非加固组发生 DSL 的患者均需再次手术，而加固组中仅 1 例患者需要保守治疗。
腹腔镜下 R-Y 重建胃切除术中十二指肠残端加固可降低 DSL 发生风险并减轻其严重程度。
