Retrospective Cohort Study
Copyright ©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
Table 1 Clinicopathological characteristics, mean ± SD/n (%)
Variables
Categories
nDSF group (n = 318)
DSF group (n = 7)
P value
Age72.0 (63.2, 78.0)82.0 (79.5, 85.0)0.001a
GenderFemale102 (32.1)2 (28.6)1
Male216 (67.9)5 (71.4)
BMI22.3 ± 3.722.3 ± 3.70.620
ASA score171 (22.3)1 (14.3)0.757
2222 (69.8)5 (71.4)
325 (7.9)1 (14.3)
ComorbidityOVF18 (5.7)4 (57.1)< 0.001b
Heart failure or angina7 (2.2)0 (0.0)1
Bowel obstruction3 (0.9)0 (0.0)1
Digestive ulcer history5 (1.6)0 (0.0)1
Abdominal surgery history44 (13.8)0 (0.0)0.617
Tumor markerCEA5.7 ± 21.25.3 ± 20.10.170
CA-19944.5 ± 228.931.0 ± 85.00.737
AFP15.4 ± 102.39.8 ± 77.30.758
Tumor locationUpper stomach97 (30.5)1 (14.3)0.839
Lower stomach71 (22.3)2 (28.6)
Middle stomach134 (42.1)4 (57.1)
Gastroesophageal junction13 (4.1)0 (0.0)
All or multiple3 (0.9)0 (0.0)
Tumor diameter (mm)63.6 ± 43.060.8 ± 41.60.291
Pathological typeAdenocarcinoma197 (61.3)5 (71.4)0.993
Undifferentiated carcinoma114 (35.8)2 (28.6)
Neuroendocrine tumor4 (1.3)0 (0.0)
Lymphoma and others4 (1.3)0 (0.0)
Special types1 (0.3)0 (0.0)
pTpT1-2134 (42.1)3 (42.9)0.602
pT3-4184 (57.8)4 (57.1)
pNpN0-1278 (87.4)5 (71.4)0.022a
pN2-340 (12.6)2 (28.6)
Distant metastasis43 (13.5)1 (14.3)1
pStageI-II188 (59.1)3 (42.9)0.612
III-IV130 (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 approachLaparotomy129 (40.6)1 (14.3)0.210
Laparoscopy146 (45.9)6 (85.7)
Robot-assisted43 (13.5)0 (0.0)
Conversion to open surgery11 (3.5)0 (0.0)1.000
GastrectomyDG129 (40.6)4 (57.1)0.621
TG189 (59.4)3 (42.9)
Lymphadenectomy extentD1, D1 +146 (45.9)3 (42.9)0.800
D2, D2 +170 (54.0)4 (57.1)
Combined resection48 (15.1)1 (14.3)1.000
Surgical time (minute)324.8 ± 100.6348.3 ± 62.80.369
Blood loss (mL)72.7 ± 102.977.1 ± 90.50.659
Retrieved lymph nodes39.1 ± 17.644.9 ± 17.60.288
Postoperative hospitalization (days)17.5 ± 20.238.7 ± 11.7< 0.001b
Reinforcement of duodenal stump291 (91.5)7 (100.0)0.910
Embedding degree (%)94.2 ± 13.990.7 ± 8.30.820
Muscularis and serosa injury36 (11.32)2 (28.6)0.418
Bleeding in reinforcement (mL)1.5 ± 3.51.7 ± 1.90.259
Reinforcement duration (minute)9.1 ± 5.29.3 ± 3.20.659
Stump suture fixed to the intestinal wall1110 (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< 0.001bNon-anastomotic complications10.073
BMI0.945Anastomotic complications21
Gender0.310Surgical approach0.190
ASA score0.757Laparoscopic surgery0.084
OVF< 0.001bConversion to open surgery1
Heart failure or angina1Gastrectomy0.622
History of bowel obstruction1Lymphadenectomy extent1
History of digestive ulcer1Combined resection1
History of abdominal surgery0.777Surgical time0.350
CEA0.494Blood loss0.020a
CA-1990.033aRetrieved lymph nodes0.423
AFP0.042aReinforcement of duodenal stump1
Tumor location0.735Embedding degree0.142
Tumor diameter0.394Muscularis and serosa injury0.395
Pathology type0.912Bleeding in reinforcement0.790
pT0.276Reinforcement duration of duodenal stump1
pN0.582Stump suture-fixed to the intestinal wall0.100
Distant metastasis1
pStage0.505
Table 4 Multivariate logistic regression analysis of the duodenal stump fistula risk factors
Variables
OR
95%CI
P value
Age1.2011.039-1.3870.013a
CA-1990.9710.916-1.030.332
AFP0.960.675-1.3650.819
OVF22.4313.263-154.2170.002a
Blood loss0.9980.992-1.0040.523
Stump sutured to the intestinal wall0.0320.002-1.0280.695
Table 5 Firth penalized logistic regression analysis of duodenal stump fistula risk factors
Variables
OR
95%CI
P value
Age1.1571.038-1.3250.006a
CA-1991.0010.994-1.0020.217
AFP1.0050.997-1.0150.139
OVF13.0752.643-67.870.002a
Blood loss0.9990.995-1.0010.280
Stump sutured to the intestinal wall0.1120.004-1.3460.094
Table 6 Bayesian logistic regression analysis of duodenal stump fistula risk factors
Variables
OR
95%CI
P value
Age1.1871.06-1.3550.003a
CA-1990.9710.909-1.0990.530
AFP0.9160.693-1.0030.079
OVF15.6232.764-86.5770.004a
Blood loss0.9960.986-1.0010.158
Stump sutured to the intestinal wall0.0840.004-1.1850.136
Table 7 Rare events logistic regression analysis of duodenal stump fistula risk factors
Variables
OR
95%CI
P value
Age1.1571.038-1.3250.006a
CA-1991.0010.994-1.0020.217
AFP1.0050.997-1.0150.139
OVF13.0752.643-67.870.002a
Blood loss0.9990.995-1.0010.280
Stump sutured to the intestinal wall0.1100.003-1.3460.094
Table 8 Poisson regression analysis of duodenal stump fistula risk factors
Variables
OR
95%CI
P value
Age1.1461.026-1.2810.016a
CA-1990.9820.941-1.0240.394
AFP0.9910.759-1.2940.947
OVF10.7892.181-53.370.004a
Blood loss0.9980.992-1.0040.585
Stump sutured to the intestinal wall0.0750.016-1.1050.994