Importance of duodenal stump reinforcement to prevent stump leakage after gastrectomy: a large-scale multicenter retrospective study (KSCC DELICATE study)

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发表日期：

2024年7月19日

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Akihiko Sano,
Yoshiro Imai,
Takahisa Yamaguchi,
Takeo Bamba,
Naoki Shinno,
Yoshiyuki Kawashima,
Masanori Tokunaga,
Yasuaki Enokida,
Tomoya Tsukada,
Satoru Hatakeyama,
Tadashi Koga,
Shirou Kuwabara,
Naoki Urakawa,
Junichi Arai,
Manabu Yamamoto,
Itaru Yasufuku,
Hironori Iwasaki,
Masahiro Sakon,
Takuya Honboh,
Yoshihiko Kawaguchi,
Tetsuya Kusumoto,
Kazunori Shibao,
Naoki Hiki,
Nobuhiro Nakazawa,
Makoto Sakai,
Makoto Sohda,
Ken Shirabe,
Eiji Oki,
Hideo Baba,
Hiroshi Saeki

摘要

Background

The significance of reinforcement of the duodenal stump with seromuscular sutures and the effectiveness of reinforced staplers in preventing duodenal stump leakage remain unclear. We aimed to explore the importance of duodenal stump reinforcement and determine the optimal reinforcement method for preventing duodenal stump leakage.

Methods

This retrospective cohort study was conducted between January 1, 2012 and December 31, 2021, with data analyzed between December 1, 2022 and September 30, 2023. This multicenter study across 57 institutes in Japan included 16,475 patients with gastric cancer who underwent radical gastrectomies. Elective open or minimally invasive (laparoscopic or robotic) gastrectomy was performed in patients with gastric cancer.

Results

Duodenal stump leakage occurred in 153 (0.93%) of 16,475 patients. The proportions of males, patients aged ≥ 75 years, and ≥ pN1 were higher in patients with duodenal stump leakage than in those without duodenal stump leakage. The incidence of duodenal stump leakage was significantly lower in the group treated with reinforcement by seromuscular sutures or using reinforced stapler than in the group without reinforcement (0.72% vs. 1.19%, p = 0.002). Duodenal stump leakage incidence was also significantly lower in high-volume institutions than in low-volume institutions (0.70% vs. 1.65%, p = 0.047). The rate of duodenal stump leakage-related mortality was 7.8% (12/153). In the multivariate analysis, preoperative asthma and duodenal invasion were identified as independent preoperative risk factors for duodenal stump leakage-related mortality.

Conclusions

The duodenal stump should be reinforced to prevent duodenal stump leakage after radical gastrectomy in patients with gastric cancer.