Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management.
10.4174/astr.2016.90.3.157
- Author:
Hyun June PAIK
1
;
Si Hak LEE
;
Chang In CHOI
;
Dae Hwan KIM
;
Tae Yong JEON
;
Dong Heon KIM
;
Ung Bae JEON
;
Cheol Woong CHOI
;
Sun Hwi HWANG
Author Information
1. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. hwangsh@pusan.ac.kr
- Publication Type:Original Article
- Keywords:
Intestinal fistula;
Gastric neoplasms;
Gastrectomy;
Complication
- MeSH:
Comorbidity;
Fistula*;
Gastrectomy*;
Gastric Outlet Obstruction;
Humans;
Intestinal Fistula;
Multivariate Analysis;
Retrospective Studies;
Risk Factors*;
Stomach Neoplasms*
- From:Annals of Surgical Treatment and Research
2016;90(3):157-163
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: A duodenal stump fistula is one of the most severe complications after gastrectomy for gastric cancer. We aimed to analyze the risk factors for this problem, and to identify the methods used for its prevention and management. METHODS: We retrospectively reviewed the clinical data of 716 consecutive patients who underwent curative gastrectomy with a duodenal stump for gastric cancer between 2008 and 2013. RESULTS: A duodenal stump fistula occurred in 16 patients (2.2%) and there were 2 deaths in this group. Univariate analysis revealed age >60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 0.99-9.66), multiple comorbidities (OR, 4.23; 95% CI, 1.50-11.92), clinical T stage (OR, 2.91; 95% CI, 1.045-8.10), and gastric outlet obstruction (OR, 8.64; 95% CI, 2.61-28.61) to be significant factors for developing a duodenal stump fistula. Multivariate analysis identified multiple comorbidities (OR, 3.92; 95% CI, 1.30-11.80) and gastric outlet obstruction (OR, 5.62; 95% CI, 1.45-21.71) as predictors of this complication. CONCLUSION: Multiple comorbidities and gastric outlet obstruction were the main risk factors for a duodenal stump fistula. Therefore, preventive methods and aggressive management should be applied for patients at high risk.
