Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer.
Adult
Aged
Aged, 80 and over
Anastomosis, Roux-en-Y
/ adverse effects
Duodenal Diseases
/ epidemiology
Duodenum
/ surgery
Female
Follow-Up Studies
Gastrectomy
/ adverse effects
Humans
Incidence
Japan
/ epidemiology
Laparoscopy
/ adverse effects
Lymph Node Excision
/ adverse effects
Male
Middle Aged
Prognosis
Plastic Surgery Procedures
/ adverse effects
Retrospective Studies
Stomach Neoplasms
/ drug therapy
Duodenal stump leakage
Duodenal stump reinforcement
Laparoscopic distal gastrectomy
Laparoscopic total gastrectomy
Roux-en-Y reconstruction
Journal
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
ISSN: 1436-3305
Titre abrégé: Gastric Cancer
Pays: Japan
ID NLM: 100886238
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
25
12
2018
accepted:
23
02
2019
pubmed:
11
3
2019
medline:
11
2
2020
entrez:
11
3
2019
Statut:
ppublish
Résumé
Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer. This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70). Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291 min versus 258 min, p < 0.001, LTG; 325 min versus 285 min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management. Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity.
Sections du résumé
BACKGROUND
Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer.
METHODS
This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70).
RESULTS
Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291 min versus 258 min, p < 0.001, LTG; 325 min versus 285 min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management.
CONCLUSIONS
Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity.
Identifiants
pubmed: 30852781
doi: 10.1007/s10120-019-00946-8
pii: 10.1007/s10120-019-00946-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1053-1059Références
Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.
Xiong JJ, Nunes QM, Huang W, Tan CL, Ke NW, Xie SM, et al. Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol. 2013;19:8114–32.
doi: 10.3748/wjg.v19.i44.8114
pubmed: 24307808
pmcid: 3848162
Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.
doi: 10.1097/SLA.0b013e31824682f4
Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc. 2013;27:1509–20.
doi: 10.1007/s00464-012-2661-1
pubmed: 23263644
Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg. 2012;256:39–52.
doi: 10.1097/SLA.0b013e3182583e2e
pubmed: 22664559
Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S, et al. Different features of complications with Billroth-I and Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy. J Gastrointest Surg. 2011;15:2145–52.
doi: 10.1007/s11605-011-1683-7
pubmed: 21948148
Cozzaglio L, Coladonato M, Biffi R, Coniglio A, Corso V, Dionigi P, et al. Duodenal fistula after elective gastrectomy for malignant disease: an Italian retrospective multicenter study. J Gastrointest Surg. 2010;14:805–11.
doi: 10.1007/s11605-010-1166-2
pubmed: 20143272
Orsenigo E, Bissolati M, Socci C, Chiari D, Muffatti F, Nifosi J, et al. Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience. Gastric Cancer. 2014;17:733–44.
doi: 10.1007/s10120-013-0327-x
pubmed: 24399492
Paik HJ, Lee SH, Choi CI, Kim DH, Jeon TY, Kim DH, et al. Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management. Ann Surg Treat Res. 2016;90:157–63.
doi: 10.4174/astr.2016.90.3.157
pubmed: 26942159
pmcid: 4773460
Kostakis ID, Alexandrou A, Armeni E, Damaskos C, Kouraklis G, Diamantis T, et al. Comparison between minimally invasive and open gastrectomy for gastric cancer in Europe: a systematic review and meta-analysis. Scand J Surg. 2017;106:3–20.
doi: 10.1177/1457496916630654
pubmed: 26929289
Orsenigo E, Di Palo S, Tamburini A, Staudacher C. Laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a monoinstitutional Western center experience. Surg Endosc. 2011;25:140–5.
doi: 10.1007/s00464-010-1147-2
pubmed: 20535499
Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc. 2009;23:153–60.
doi: 10.1007/s00464-008-0072-0
pubmed: 18633671
Ali BI, Park CH, Song KY. Outcomes of non-operative treatment for duodenal stump leakage after gastrectomy in patients with gastric cancer. J Gastric Cancer. 2016;16:28–33.
doi: 10.5230/jgc.2016.16.1.28
pubmed: 27104024
pmcid: 4834618
Kim KH, Kim MC, Jung GJ. Risk factors for duodenal stump leakage after gastrectomy for gastric cancer and management technique of stump leakage. Hepatogastroenterology. 2014;61:1446–53.
pubmed: 25436323