Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2024
Surgical technique and safety of gastrectomy for gastric cancer with duodenal invasion, including minimally invasive approach.
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Yokoo Hiroki, Kanaji Shingo, Ikeda Taro, Koterazawa Yasufumi, Sawada Ryuichiro, Harada Hitoshi, Urakawa Naoki, Goto Hironobu, Hasegawa Hiroshi, Yamashita Kimihiro, Matsuda Takeru, Kakeji Yoshihiro
Аннотация
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.
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.