Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictive model and prognostic insights into duodenal stump fistula following radical gastrectomy with Roux-en-Y reconstruction for gastric cancer
Yang Yu, Suguru Yamauchi, Sanae Kaji, Yukinori Yube, Motomi Nasu, Yutaro Yoshimoto, Ming Cheng, Asako Ozaki, Takehiro Watanabe, Hajime Orita, Kaitlyn Ecoff, Shuko Nojiri, Shinji Mine, Yong-You Wu, Tetsu Fukunaga
Yang Yu, Suguru Yamauchi, Sanae Kaji, Yukinori Yube, Motomi Nasu, Yutaro Yoshimoto, Ming Cheng, Asako Ozaki, Takehiro Watanabe, Hajime Orita, Shinji Mine, Yong-You Wu, Tetsu Fukunaga, Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
Yang Yu, Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
Suguru Yamauchi, Kaitlyn Ecoff, Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, United States
Ming Cheng, Yong-You Wu, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Shuko Nojiri, Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan
Co-corresponding authors: Suguru Yamauchi and Tetsu Fukunaga.
Author contributions: Fukunaga T designed the research; Kaji S, Yube Y, and Yu Y collected the clinical data; Yu Y analyzed the data; Yu Y and Yamauchi S wrote the paper; Yamauchi S, Kaji S, Yube Y, Nasu M, Yoshimoto Y, Cheng M, Ozaki A, Watanabe T, Orita H, Ecoff K, Nojiri S, Mine S, and Wu YY participated in the review and editing; Nojiri S confirmed the appropriateness of the statistics; Fukunaga T corrected and approved the manuscript; Yamauchi S and Fukunaga T contributed equally as co–corresponding authors, jointly guiding the interpretation of results and overall study direction; Fukunaga T is the designated contact for all journal correspondence.
Supported by the China Scholarship Council Fund, No. 202308050094.
Institutional review board statement: This study was approved by the Institutional Ethics Committee of Juntendo University Hospital (No. H20-0396).
Informed consent statement: The need for informed consent was waived given the retrospective and observational nature of the study. An opt-out approach was used by accessing a written disclosure on the study’s website (URL:
https://www.gcprec.juntendo.ac.jp/kenkyu/detail/3222).
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tetsu Fukunaga, MD, PhD, Chief Physician, Professor, Department of Esophageal and Gastroenterological Surgery, Juntendo University, 2-1-1 Hongo Bunkyo Ward, Tokyo 113-8431, Japan.
t2fukunaga@gmail.com
Received: December 18, 2024
Revised: March 24, 2025
Accepted: April 29, 2025
Published online: June 27, 2025
Processing time: 164 Days and 1.6 Hours
BACKGROUND
Duodenal stump fistula (DSF) is a rare yet serious complication following gastric cancer surgery. The risk factors associated with DSF, as well as the predictive models, remain insufficiently elucidated.
AIM
To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis, develop a predictive model, and evaluate impact on prognosis.
METHODS
This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021 (n = 325). Univariate and multivariate analyses were performed to identify the risk factors associated with DSF. Based on the independent risk factors, a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis. Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).
RESULTS
Among the 325 patients analyzed, DSF was observed in 7 (2.2%) cases. No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used. Multivariate analysis confirmed that age [odds ratio (OR) = 1.17, P = 0.015] and obstructive ventilatory failure (OVF) (OR = 14.03, P = 0.001) were independent risk factors for DSF. The predictive nomogram was constructed based on age and OVF, which exhibited strong performance (area under the curve = 0.90, 95% confidence interval: 0.82-0.99). Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF, whereas no significant differences were observed in OS or DFS.
CONCLUSION
Age and OVF are independent risk factors for DSF, which worsens CSS. A nomogram predicts DSF accurately, and innovative surgical techniques may reduce its occurrence.
Core Tip: This retrospective cohort study included 325 patients who underwent radical gastrectomy with Roux-en-Y reconstruction to identify risk factors for duodenal stump fistula (DSF). Age and obstructive ventilatory failure were identified as independent risk factors for DSF. A nomogram incorporating these risk factors demonstrated robust predictive performance for DSF. DSF significantly affected cancer-specific survival. Suturing fixation of the duodenal stump to the jejunal wall has shown potential as an effective strategy for preventing DSF.
