Yokoo Hiroki, Kanaji Shingo, Ikeda Taro, Koterazawa Yasufumi, Sawada Ryuichiro, Harada Hitoshi, Urakawa Naoki, Goto Hironobu, Hasegawa Hiroshi, Yamashita Kimihiro, Matsuda Takeru, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
J Gastrointest Surg. 2025 Mar;29(3):101934. doi: 10.1016/j.gassur.2024.101934. Epub 2024 Dec 17.
Gastrectomy for gastric cancer with duodenal invasion poses an oncologic (high positive rate of resection line infiltration) and a surgical (high risk of duodenal fistula) challenge. This study aimed to validate the safety of gastrectomy for gastric cancer with duodenal invasion.
A total of 82 patients with distal gastric cancer who underwent gastrectomy and reconstruction via the Billroth II or Roux-en-Y procedure at Kobe University Hospital between 2011 and 2021 were retrospectively reviewed. Of these, 37 patients had duodenal invasion (Duo+ group) and 45 patients did not have duodenal invasion (Duo- group). Clinicopathologic findings were compared between groups. A Video (available online at http://doi.org/10.1016/j.gassur.2024.101934) is provided to demonstrate our surgical technique for duodenal resection and duodenal stump reinforcement.
Resected duodenum length was significantly longer in the Duo+ group than in the Duo- group (3 vs 1 cm, P <.001). None of the patients in either group had positive distal resection line infiltration in the surgical specimen. Incidence of duodenal stump fistula (2.7% vs 0%, P =.27) and 5-year overall survival rate (30% vs 30%, P =.67) were comparable between the 2 groups.
Gastrectomy for gastric cancer with duodenal invasion can be performed safely. Our surgical approach may have contributed to the safety of gastrectomy for gastric cancer with duodenal invasion.
对于侵犯十二指肠的胃癌患者进行胃切除术面临肿瘤学（切缘浸润阳性率高）和外科手术（十二指肠瘘风险高）方面的挑战。本研究旨在验证侵犯十二指肠的胃癌患者行胃切除术的安全性。
回顾性分析2011年至2021年在神户大学医院接受胃切除术并采用毕罗Ⅱ式或 Roux-en-Y 吻合术重建消化道的82例远端胃癌患者。其中，37例患者存在十二指肠侵犯（Duo+组），45例患者无十二指肠侵犯（Duo-组）。比较两组的临床病理特征。提供一段视频（可在http://doi.org/10.1016/j.gassur.2024.101934在线观看）展示十二指肠切除及十二指肠残端加固的手术技术。
Duo+组切除的十二指肠长度显著长于Duo-组（3 cm 对1 cm，P <.001）。两组患者手术标本的远端切缘浸润均为阴性。两组十二指肠残端瘘的发生率（2.7%对0%，P =.27）和5年总生存率（30%对30%，P =.67）相当。
侵犯十二指肠的胃癌患者行胃切除术可安全实施。我们的手术方法可能有助于提高侵犯十二指肠的胃癌患者胃切除术的安全性。
