Liu Pengfei, Lang Jianhua, Wu Jianzhong, Shen Genhai, Qian Zhenghai, Wu Chuanfu, Shen Tao, Qiu Jie, Gu Zhigang
Department of General Surgery, Suzhou Ninth People'S Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.
Surg Endosc. 2025 May;39(5):2799-2813. doi: 10.1007/s00464-025-11624-5. Epub 2025 Mar 7.
This study aimed to evaluate the safety and reliability of an innovative technique-fixation of the food loop and duodenal stump-by investigating its impact on postoperative complications and overall survival (OS) in patients undergoing distal gastrectomy with Roux-en-Y reconstruction.
A retrospective analysis was conducted on patients who underwent radical distal gastrectomy and Roux-en-Y reconstruction at Suzhou Ninth People's Hospital between January 2012 and December 2023. Patients were divided into with duodenum fixation and without duodenum fixation groups based on whether food loop and duodenal stump fixation was performed during surgery. Propensity score matching (PSM) was used to match 95 pairs of patients, and differences in baseline characteristics, postoperative complications, subgroup analysis, and survival outcomes were compared. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for postoperative complications.
After PSM, there were no significant differences between the two groups in terms of baseline characteristics, operative time, estimated blood loss, time to first flatus, or postoperative length of hospital stay (P > 0.05). The overall incidence of postoperative complications showed no significant differences between the two groups (P > 0.05). The incidence of Roux-en-Y stasis syndrome (RSS) was significantly lower in the fixation group (P = 0.035). Subgroup analysis revealed that duodenal stump fixation had no significant effect on the overall incidence of postoperative complications across various subgroups (all P > 0.05). Survival analysis indicated that duodenal stump fixation had no significant effect on OS (P = 0.33).
The novel technique of food loop and duodenal stump fixation significantly reduces the incidence of Roux-en-Y stasis syndrome without increasing the risk of postoperative complications or affecting long-term prognosis, demonstrating its safety and reliability in distal gastric cancer surgery.
本研究旨在通过调查一种创新技术——食物袢与十二指肠残端固定术对接受远端胃切除术并进行Roux-en-Y重建的患者术后并发症和总生存期（OS）的影响，来评估该技术的安全性和可靠性。
对2012年1月至2023年12月期间在苏州第九人民医院接受根治性远端胃切除术和Roux-en-Y重建的患者进行回顾性分析。根据手术中是否进行食物袢和十二指肠残端固定，将患者分为十二指肠固定组和非十二指肠固定组。采用倾向评分匹配（PSM）法匹配95对患者，并比较两组患者的基线特征、术后并发症、亚组分析和生存结局的差异。进行单因素和多因素逻辑回归分析，以确定术后并发症的独立危险因素。
PSM后，两组患者在基线特征、手术时间、估计失血量、首次排气时间或术后住院时间方面无显著差异（P>0.05）。两组患者术后并发症的总发生率无显著差异（P>0.05）。固定组的Roux-en-Y淤滞综合征（RSS）发生率显著低于非固定组（P=0.035）。亚组分析显示，十二指肠残端固定对各亚组术后并发症的总发生率无显著影响（所有P>0.05）。生存分析表明，十二指肠残端固定对OS无显著影响（P=0.33）。
食物袢和十二指肠残端固定的新技术显著降低了Roux-en-Y淤滞综合征的发生率，且不增加术后并发症风险或影响长期预后，证明了其在远端胃癌手术中的安全性和可靠性。
