Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7571-7576
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7571
Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review
Paolo Aurello, Dario Sirimarco, Paolo Magistri, Niccolò Petrucciani, Giammauro Berardi, Silvia Amato, Marcello Gasparrini, Francesco D’Angelo, Giuseppe Nigri, Giovanni Ramacciato
Paolo Aurello, Dario Sirimarco, Paolo Magistri, Niccolò Petrucciani, Giammauro Berardi, Silvia Amato, Marcello Gasparrini, Francesco D’Angelo, Giuseppe Nigri, Giovanni Ramacciato, Department of General Surgery, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
Author contributions: Aurello P contributed to concept of the manuscript and final revision; Sirimarco D, Magistri P contributed to study design and acquisition of data; Petrucciani N, Berardi G, Gasparrini M, and D’Angelo F contributed to analysis and interpretation of data; Amato S drafted manuscript and made final revision; Nigri G and Ramacciato G revised the manuscript and made final approval.
Conflict-of-interest: The authors declare no conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dario Sirimarco, MD, Department of General Surgery, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy. sir.dario@hotmail.it
Telephone: +39-633-775632 Fax: +39-633-775649
Received: December 23, 2014
Peer-review started: December 24, 2014
First decision: January 23, 2015
Revised: February 14, 2015
Accepted: April 9, 2015
Article in press: April 9, 2015
Published online: June 28, 2015
Abstract

AIM: To identify the most effective treatment of duodenal stump fistula (DSF) after gastrectomy for gastric cancer.

METHODS: A systematic review of the literature was performed. PubMed, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and UpToDate databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients’ characteristics, type of treatment, short and long-term outcomes were extracted and analyzed.

RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach (3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodeno-jejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy (32 cases) and percutaneous biliary diversion (13 cases). The median healing time in this group was 43 d.

CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail.

Keywords: Duodenal stump leak, Duodenal stump fistula, Gastric cancer, Management, Gastrectomy

Core tip: To our knowledge, this is the first review available in the literature focusing on the duodenal stump fistula following resection for gastric cancer. Previous review have been published concerning this topic but not limited to oncologic patients. Furthermore, in this review, a more recent time period is analyzed, increasing reliability of the conclusions of the manuscript considering advancement in technologies and treatment strategies.