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

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.