Abe Takashi, Fujiya Keiichi, Terashima Masanori, Notsu Akifumi, Matsumoto Yosuke, Koseki Yusuke, Furukawa Kenichiro, Tanizawa Yutaka, Bando Etsuro
Division of Gastric Surgery, Shizuoka Cancer Center, Sunto District, Japan.
Clinical Research Center, Shizuoka Cancer Center, Sunto District, Japan.
World J Surg. 2025 Jun;49(6):1591-1599. doi: 10.1002/wjs.12610. Epub 2025 May 9.
Duodenal stump leakage (DSL) is a serious complication in gastrectomy. However, its risk factors remain unknown. Moreover, whether duodenal stump reinforcement can effectively prevent DSL is unclear. Therefore, the present study aimed to identify the risk factors for DSL and to assess the efficacy of duodenal stump reinforcement in preventing DSL.
A total of 1918 patients with primary gastric cancer who underwent total or distal gastrectomy with Roux-en-Y reconstruction at our institution between 2012 and 2023 were included in this study. Multivariate analysis was conducted to identify the risk factors for DSL and to determine the efficacy of duodenal stump reinforcement in preventing DSL.
Among the patients, 660 were aged 75 years or older, 1387 were male, and 447 had a body mass index (BMI) ≥ 25. Open surgery was the most commonly performed surgical approach (1121 patients), followed by laparoscopic surgery (540 patients) and robotic surgery (257 patients). DSL occurred in 24 patients (1%). The multivariate analysis showed that overweight with a BMI ≥ 25 and laparoscopic surgery were independent risk factors for DSL, and duodenal stump reinforcement was an independent preventive factor for DSL. Regarding the duodenal stump reinforcement procedure, DSL occurred in four patients (0.6%) who underwent interrupted sutures, but not in those who underwent purse-string sutures.
Overweight with a BMI ≥ 25 and laparoscopic surgery were identified as risk factors for DSL in gastrectomy and duodenal stump reinforcement appeared to be effective in preventing DSL.
十二指肠残端漏（DSL）是胃切除术中的一种严重并发症。然而，其危险因素尚不清楚。此外，十二指肠残端加固能否有效预防DSL也不明确。因此，本研究旨在确定DSL的危险因素，并评估十二指肠残端加固在预防DSL方面的疗效。
本研究纳入了2012年至2023年期间在我院接受全胃或远端胃切除术并进行Roux-en-Y重建的1918例原发性胃癌患者。进行多因素分析以确定DSL的危险因素，并确定十二指肠残端加固在预防DSL方面的疗效。
在这些患者中，660例年龄在75岁及以上，1387例为男性，447例体重指数（BMI）≥25。开放手术是最常用的手术方式（1121例患者），其次是腹腔镜手术（540例患者）和机器人手术（257例患者）。24例患者（1%）发生了DSL。多因素分析显示，BMI≥25的超重和腹腔镜手术是DSL的独立危险因素，而十二指肠残端加固是DSL的独立预防因素。关于十二指肠残端加固手术，接受间断缝合的4例患者（0.6%）发生了DSL，而接受荷包缝合的患者未发生DSL。
BMI≥25的超重和腹腔镜手术被确定为胃切除术中DSL的危险因素，十二指肠残端加固似乎对预防DSL有效。
