The incidence of duodenal stump leakage after gastrectomy for gastric cancer:A prospective multicenter observational study
MIAO Ru-lin
REN Shuang-yi
ZHANG Tao
TIAN Yan-tao
QU Jian-jun
PAN Yuan
WANG Quan
LIANG Pin
YU Wen-bin
LI Zi-yu
Abstract：Objective To explore the incidence,risk factors,and diagnostic value of postoperative drainage fluid analysis in detecting duodenal stump leakage(DSL)following gastric cancer surgery under current surgical conditions in China.Methods A prospective multicenter observational study was conducted,enrolling 1036 patients who underwent gastric cancer surgery at nine centers in China between February 2021 and December 2022.Postoperative drainage fluid amylase and direct bilirubin levels were monitored on days 1,3,5,and 7.The primary endpoint was the incidence of DSL,while secondary endpoints included Clavien-Dindo classification,complication rates,and dynamic changes in biochemical indicators of drainage fluid.Results The overall incidence of DSL was 0.97％(10/1036),with the majority of cases classified as Clavien-Dindo grade Ⅱ(50.0％)and Ⅲ a(30.0％).The proportion of patients with cardiovascular and cerebrovascular comorbidities was significantly higher in the DSL group compared to the non-DSL group(60.0％vs.23.7％,P=0.016).The incidence of DSL was significantly higher in the hand-sewn anastomosis group compared to the stapler closure group(33.3％vs.0.9％,P=0.029).The hospital stay for patients with DSL was significantly longer than for those without DSL(24.4 days vs.10.9 days,P＜0.001).Amylase and direct bilirubin levels in the drainage fluid showed a persistent increase in the DSL group(reaching 35250.2 U/L and 44.9 μmol/L on day 7 postoperatively,respectively),but the differences between groups were not statistically significant.All DSL cases were cured with fasting,gastrointestinal decompression,somatostatin,antibiotics,and adequate drainage,with no mortality.Conclusion The incidence of DSL after gastric cancer surgery has decreased to 0.97％,and stapler closure of the duodenal stump is a safe and feasible approach.Dynamic monitoring of amylase and direct bilirubin levels in postoperative drainage fluid may provide early diagnostic evidence,but larger sample studies are needed for validation.
Keywords：gastric cancerduodenal stump leakageprospective multicenter studylinear staplerClavien-Dindo classificationdrainage fluid amylasedirect bilirubinmanual transection
Publication Date：2025-03-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 309-315 )