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©The Author(s) 2025.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 104333
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.104333
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.104333
Table 1 Clinicopathological characteristics, mean ± SD/n (%)
Variables | Categories | nDSF group (n = 318) | DSF group (n = 7) | P value |
Age | 72.0 (63.2, 78.0) | 82.0 (79.5, 85.0) | 0.001a | |
Gender | Female | 102 (32.1) | 2 (28.6) | 1 |
Male | 216 (67.9) | 5 (71.4) | ||
BMI | 22.3 ± 3.7 | 22.3 ± 3.7 | 0.620 | |
ASA score | 1 | 71 (22.3) | 1 (14.3) | 0.757 |
2 | 222 (69.8) | 5 (71.4) | ||
3 | 25 (7.9) | 1 (14.3) | ||
Comorbidity | OVF | 18 (5.7) | 4 (57.1) | < 0.001b |
Heart failure or angina | 7 (2.2) | 0 (0.0) | 1 | |
Bowel obstruction | 3 (0.9) | 0 (0.0) | 1 | |
Digestive ulcer history | 5 (1.6) | 0 (0.0) | 1 | |
Abdominal surgery history | 44 (13.8) | 0 (0.0) | 0.617 | |
Tumor marker | CEA | 5.7 ± 21.2 | 5.3 ± 20.1 | 0.170 |
CA-199 | 44.5 ± 228.9 | 31.0 ± 85.0 | 0.737 | |
AFP | 15.4 ± 102.3 | 9.8 ± 77.3 | 0.758 | |
Tumor location | Upper stomach | 97 (30.5) | 1 (14.3) | 0.839 |
Lower stomach | 71 (22.3) | 2 (28.6) | ||
Middle stomach | 134 (42.1) | 4 (57.1) | ||
Gastroesophageal junction | 13 (4.1) | 0 (0.0) | ||
All or multiple | 3 (0.9) | 0 (0.0) | ||
Tumor diameter (mm) | 63.6 ± 43.0 | 60.8 ± 41.6 | 0.291 | |
Pathological type | Adenocarcinoma | 197 (61.3) | 5 (71.4) | 0.993 |
Undifferentiated carcinoma | 114 (35.8) | 2 (28.6) | ||
Neuroendocrine tumor | 4 (1.3) | 0 (0.0) | ||
Lymphoma and others | 4 (1.3) | 0 (0.0) | ||
Special types | 1 (0.3) | 0 (0.0) | ||
pT | pT1-2 | 134 (42.1) | 3 (42.9) | 0.602 |
pT3-4 | 184 (57.8) | 4 (57.1) | ||
pN | pN0-1 | 278 (87.4) | 5 (71.4) | 0.022a |
pN2-3 | 40 (12.6) | 2 (28.6) | ||
Distant metastasis | 43 (13.5) | 1 (14.3) | 1 | |
pStage | I-II | 188 (59.1) | 3 (42.9) | 0.612 |
III-IV | 130 (40.9) | 4 (47.2) | ||
Non-anastomotic complication (≥ Grade 3a) | 52 (16.4) | 5 (71.4) | < 0.001b | |
Anastomotic complications except DSF (≥ Grade 3a) | 11 (3.5) | 0 (0.0) | 0.993 |
Table 2 Perioperative outcomes, mean ± SD/n (%)
Variables | Categories | nDSF group (n = 318) | DSF group (n = 7) | P value |
Surgical approach | Laparotomy | 129 (40.6) | 1 (14.3) | 0.210 |
Laparoscopy | 146 (45.9) | 6 (85.7) | ||
Robot-assisted | 43 (13.5) | 0 (0.0) | ||
Conversion to open surgery | 11 (3.5) | 0 (0.0) | 1.000 | |
Gastrectomy | DG | 129 (40.6) | 4 (57.1) | 0.621 |
TG | 189 (59.4) | 3 (42.9) | ||
Lymphadenectomy extent | D1, D1 + | 146 (45.9) | 3 (42.9) | 0.800 |
D2, D2 + | 170 (54.0) | 4 (57.1) | ||
Combined resection | 48 (15.1) | 1 (14.3) | 1.000 | |
Surgical time (minute) | 324.8 ± 100.6 | 348.3 ± 62.8 | 0.369 | |
Blood loss (mL) | 72.7 ± 102.9 | 77.1 ± 90.5 | 0.659 | |
Retrieved lymph nodes | 39.1 ± 17.6 | 44.9 ± 17.6 | 0.288 | |
Postoperative hospitalization (days) | 17.5 ± 20.2 | 38.7 ± 11.7 | < 0.001b | |
Reinforcement of duodenal stump | 291 (91.5) | 7 (100.0) | 0.910 | |
Embedding degree (%) | 94.2 ± 13.9 | 90.7 ± 8.3 | 0.820 | |
Muscularis and serosa injury | 36 (11.32) | 2 (28.6) | 0.418 | |
Bleeding in reinforcement (mL) | 1.5 ± 3.5 | 1.7 ± 1.9 | 0.259 | |
Reinforcement duration (minute) | 9.1 ± 5.2 | 9.3 ± 3.2 | 0.659 | |
Stump suture fixed to the intestinal wall1 | 110 (34.6) | 0 (0.0) | 0.131 |
Table 3 Univariate logistic regression analysis of the duodenal stump fistula risk factors
Variables (clinicopathological factors) | P value | Variables (perioperative factors) | P value |
Age | < 0.001b | Non-anastomotic complications1 | 0.073 |
BMI | 0.945 | Anastomotic complications2 | 1 |
Gender | 0.310 | Surgical approach | 0.190 |
ASA score | 0.757 | Laparoscopic surgery | 0.084 |
OVF | < 0.001b | Conversion to open surgery | 1 |
Heart failure or angina | 1 | Gastrectomy | 0.622 |
History of bowel obstruction | 1 | Lymphadenectomy extent | 1 |
History of digestive ulcer | 1 | Combined resection | 1 |
History of abdominal surgery | 0.777 | Surgical time | 0.350 |
CEA | 0.494 | Blood loss | 0.020a |
CA-199 | 0.033a | Retrieved lymph nodes | 0.423 |
AFP | 0.042a | Reinforcement of duodenal stump | 1 |
Tumor location | 0.735 | Embedding degree | 0.142 |
Tumor diameter | 0.394 | Muscularis and serosa injury | 0.395 |
Pathology type | 0.912 | Bleeding in reinforcement | 0.790 |
pT | 0.276 | Reinforcement duration of duodenal stump | 1 |
pN | 0.582 | Stump suture-fixed to the intestinal wall | 0.100 |
Distant metastasis | 1 | ||
pStage | 0.505 |
Table 4 Multivariate logistic regression analysis of the duodenal stump fistula risk factors
Table 5 Firth penalized logistic regression analysis of duodenal stump fistula risk factors
Table 6 Bayesian logistic regression analysis of duodenal stump fistula risk factors
Table 7 Rare events logistic regression analysis of duodenal stump fistula risk factors
Table 8 Poisson regression analysis of duodenal stump fistula risk factors
- Citation: Yu Y, Yamauchi S, Kaji S, Yube Y, Nasu M, Yoshimoto Y, Cheng M, Ozaki A, Watanabe T, Orita H, Ecoff K, Nojiri S, Mine S, Wu YY, Fukunaga T. Predictive model and prognostic insights into duodenal stump fistula following radical gastrectomy with Roux-en-Y reconstruction for gastric cancer. World J Gastrointest Surg 2025; 17(6): 104333
- URL: https://www.wjgnet.com/1948-9366/full/v17/i6/104333.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v17.i6.104333