Zizzo Maurizio, Morini Andrea, Zanelli Magda, Broggi Giuseppe, Sanguedolce Francesca, Koufopoulos Nektarios I, Palicelli Andrea, Mangone Lucia, Fabozzi Massimiliano, Giuffrida Mario, Bonelli Candida, Marchesi Federico
Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.
Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.
Cancers (Basel). 2025 May 22;17(11):1735. doi: 10.3390/cancers17111735.
: Duodenal stump fistula (DSF) is one of the most feared postoperative complications in gastric cancer surgery. It has a 1.6-5% incidence rate and correlates with potentially high rates of morbidity (75%) and mortality (16-20%). The absence of duodenal stump reinforcement is considered one of the main risk factors. Our meta-analysis aimed to provide updated evidence by comparing DSF rates among patients who underwent distal or total gastrectomy for malignant gastric disease with or without reinforcement of the duodenal stump. : We performed a systematic review following the PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library databases were used to identify articles of interest. Meta-analysis was performed by using RevMan Version 5.4. : The six included comparative studies (19,527 patients: 11,545 reinforcement group versus 7982 control group) covered an approximately 20-year study period (2005-2023). All the studies included were observational in nature. Meta-analysis of pooled results showed that, compared to the control group, the reinforcement group recorded a statistically significant lower DSF rate (OR: 0.32, 95% CI: 0.17, 0.60, = 0.0004). Considering secondary outcomes, no statistically significant differences were identified between the two groups in terms of operative time, EBL, overall postoperative complications, and length of hospital stay. Just major postoperative complications were considerably lower in the reinforcement group compared to the control group (OR: 0.66, 95% CI: 0.43, 0.99, = 0.04). : Duodenal stump reinforcement appears to reduce the rate of DSF after distal or total gastrectomy for malignant gastric disease. Given the significant biases among meta-analyzed studies, our results require careful interpretation. Further randomized, possibly multicenter trials may turn out to be of paramount importance in confirming our results.
十二指肠残端瘘（DSF）是胃癌手术中最可怕的术后并发症之一。其发生率为1.6% - 5%，且与较高的发病率（75%）和死亡率（16% - 20%）相关。未进行十二指肠残端加固被认为是主要危险因素之一。我们的荟萃分析旨在通过比较接受远端或全胃切除术治疗恶性胃部疾病且有或无十二指肠残端加固的患者的DSF发生率，提供最新证据。
我们按照PRISMA指南进行了系统评价。使用PubMed/MEDLINE、Scopus、Web of Science、Embase和Cochrane图书馆数据库来识别感兴趣的文章。使用RevMan 5.4版进行荟萃分析。
纳入的六项比较研究（19527例患者：11545例加固组与7982例对照组）涵盖了约20年的研究期（2005 - 2023年）。所有纳入的研究本质上都是观察性的。汇总结果的荟萃分析表明，与对照组相比，加固组的DSF发生率在统计学上显著更低（OR：0.32，95%CI：0.17，0.60，P = 0.0004）。考虑次要结局，两组在手术时间、术中出血量、总体术后并发症和住院时间方面未发现统计学上的显著差异。仅加固组的术后主要并发症明显低于对照组（OR：0.66，95%CI：0.43，0.99，P = 0.04）。
十二指肠残端加固似乎可降低恶性胃部疾病远端或全胃切除术后的DSF发生率。鉴于荟萃分析研究中存在显著偏倚，我们的结果需要谨慎解读。进一步的随机、可能多中心试验对于证实我们的结果可能至关重要。
