Factors Affecting Duodenal Stump Leakage After Gastrectomy

Abstract Introduction Gastric adenocarcinoma is the fourth most common and the second deadliest cancer worldwide. Postoperative duodenal stump leakage is a potentially life-threatening complication. Its incidence is approximately 3%, with a morbidity rate of 75% and a mortality rate reaching up to 20%. Method Patients diagnosed with gastric adenocarcinoma and operated on at Marmara University Pendik Training and Research Hospital between 2014 and 2020 were retrospectively reviewed using the hospital database. The demographic characteristics, perioperative features (hospital stay, surgical procedures, duodenal stump closure method), and risk factors for duodenal stump leakage were analyzed. Results A total of 618 patients were included in the study. Of these, 269 patients (43.5%) underwent Distal Subtotal Gastrectomy (DSG), and 349 patients (56.5%) underwent Total Gastrectomy. The mean age was found to be 63 (± 12). Duodenal stump leakage was observed in 21 patients (3%). Patients with a Charlson Comorbidity Index score of 3 or higher had a significantly higher rate of leaks ( p = 0.003). When examining the type of operation, patients who underwent DSG with Billroth-II anastomosis had a higher leakage rate ( p = 0.029). The method of duodenal stump closure and the use of reinforcement sutures on the stump did not significantly affect leakage rates. Conclusion No significant difference was observed in duodenal stump leakage rates based on the method used for stump closure in patients operated on for gastric cancer. However, the presence of comorbidities and the use of Billroth-II reconstruction in DSG were identified as risk factors for stump leakage.