Surgical technique and safety of gastrectomy for gastric cancer with duodenal invasion, including minimally invasive approach

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastrointestinal Surgery Pub Date : 2025-03-01 Epub Date: 2024-12-17 DOI:10.1016/j.gassur.2024.101934

Hiroki Yokoo, Shingo Kanaji, Taro Ikeda, Yasufumi Koterazawa, Ryuichiro Sawada, Hitoshi Harada, Naoki Urakawa, Hironobu Goto, Hiroshi Hasegawa, Kimihiro Yamashita, Takeru Matsuda, Yoshihiro Kakeji

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Abstract

Background

Gastrectomy for gastric cancer with duodenal invasion poses an oncologic (high positive rate of resection line infiltration) and a surgical (high risk of duodenal fistula) challenge. This study aimed to validate the safety of gastrectomy for gastric cancer with duodenal invasion.

Methods

A total of 82 patients with distal gastric cancer who underwent gastrectomy and reconstruction via the Billroth II or Roux-en-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). Clinicopathologic findings were compared between groups. A Video (available online at http://doi.org/10.1016/j.gassur.2024.101934) 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 1 cm, P <.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 =.27) and 5-year overall survival rate (30% vs 30%, P =.67) were comparable between the 2 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.

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十二指肠受侵胃癌切除术（包括微创法）的手术技术和安全性

背景：胃癌伴十二指肠侵犯行胃切除术对肿瘤学（切除线浸润阳性率高）和外科（十二指肠瘘风险高）提出了挑战。本研究的目的是验证胃切除术治疗侵犯十二指肠的胃癌的安全性。方法：我们回顾性分析了2011年至2021年间在神户大学医院接受胃切除术并通过Bill-II或R-Y手术重建的82例远端胃癌患者。其中有十二指肠侵犯37例（Duo+组），无十二指肠侵犯45例（Duo-组）。比较两组临床病理表现。我们提供了一段视频来展示我们的手术技术十二指肠切除术和十二指肠残端加固。结果：Duo+组切除的十二指肠长度明显长于Duo-组（3 cm vs. 1cm, P < 0.001）。两组患者均未见手术标本中远端切除线浸润阳性。两组十二指肠残端瘘发生率（2.7% vs. 0%, P = 0.27）和5年总生存率（30% vs. 30%, P = 0.67）具有可比性。结论：侵犯十二指肠的胃癌行胃切除术是安全的。我们的手术方法可能提高了胃切除术对侵犯十二指肠的胃癌的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Surgery 医学-外科

CiteScore

5.50

自引率

3.10%

发文量

319

审稿时长

2 months

期刊介绍： The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.