Risk factors for development of duodenal stump leakage in gastric adenocarcinoma and comparison of treatment modalities

The aim of this study is to reexamine the risk factors of duodenal stump leakage (DSL) and comparison of the treatment modalities of this complication in our center, despite risk-reducing approaches which had been defined in literature. Between August 2004 and May 2020 all the patients older than 18 who underwent radical total gastrectomy and distal subtotal gastrectomy due to gastric adenocarcinoma were retrospectively evaluated. After exclusion criterias the clinicopathological data set of 565 patients are collected. Duodenal stump leakage was detected in 21 patients. Preoperative, peroperative and postoperative data were obtained and the risk factors leading to DSL were found. Also; in addition to perioperative parameters, the distance from the location where the duodenum divides, to the fixed point where the distal choledocus intersects with the duodenum (stump length) was calculated and its effect on DSL was searched. In the multivariant analyse; alcohol comsumption (p<0.01), use of six-row stapler (p=0.023), peroperative blood transfusion (p<0.01), inappearance of gastroduodenal artery (GDA) in postoperative computed tomography (p<0.01) and stump length (p=0.013) were independent risk factors for development of DSL. The survival time of patients was evaluated by Kaplan-Meier statistical analysis. It was observed that, the survival time and develoment of recurrence was not affected in patients with DSL. In this study, alcohol comsumption, use of six-row stapler, peroperative blood transfusion, inappearance of gastroduodenal artery (GDA) and stump length are the risk factors which were not evaluated as risk factors in literature before. In addition, it has been proven that the risk of DSL was decreased as one goes distally, for resection of the duodenum in the gastrectomy procedure. Key Words: duodenal stump leakage, gastric adenocarcinoma, duodenal pacemaker, stump length, stapler