KMID : 0371420160900030157
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Annals of Surgical Treatment and Research 2016 Volume.90 No. 3 p.157 ~ p.163
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Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management
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Paik Hyun-June
Lee Si-Hak Choi Chang-In Kim Dae-Hwan Jeon Tae-Yong Kim Dong-Heon Jeon Ung-Bae Choi Cheol-Woong Hwang Sun-Hwi
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Abstract
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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.
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KEYWORD
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Intestinal fistula, Gastric neoplasms, Gastrectomy, Complication
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