Surgical Technique and Safety of Gastrectomy for Gastric Cancer with Duodenal Invasion, Including Minimally Invasive Approach.

Abstract

Background: Gastrectomy for gastric cancer with duodenal invasion poses an oncological (high positive rate of resection line infiltration) and a surgical (high risk of duodenal fistula) challenge. The purpose of this study was to validate the safety of gastrectomy for gastric cancer with duodenal invasion.

Methods: We included 82 patients with distal gastric cancer who underwent gastrectomy and reconstruction via the Bill-II or R-Y procedure at Kobe University Hospital between 2011 and 2021 were retrospectively reviewed. Of these, 37 patients had duodenal invasion (Duo+ group) and 45 patients did not have duodenal invasion (Duo- group). Clinicopathological findings were compared between groups. A video is provided to demonstrate our surgical technique for duodenal resection and duodenal stump reinforcement.

Results: Resected duodenum length was significantly longer in the Duo+ group than in the Duo- group (3 vs. 1cm, P < 0.001). None of the patients in either group had positive distal resection line infiltration in the surgical specimen. Incidence of duodenal stump fistula (2.7% vs. 0%, P = 0.27) and 5-year overall survival rate (30% vs. 30%, P = 0.67) were comparable between the two groups.

Conclusion: Gastrectomy for gastric cancer with duodenal invasion can be performed safely. Our surgical approach may have contributed to the safety of gastrectomy for gastric cancer with duodenal invasion.