Predictive model and prognostic insights into duodenal stump fistula following radical gastrectomy with Roux-en-Y reconstruction for gastric cancer

Yang Yu; Suguru Yamauchi; Sanae Kaji; Yukinori Yube; Motomi Nasu; Yutaro Yoshimoto; Ming Cheng; Asako Ozaki; Takehiro Watanabe; Hajime Orita; Kaitlyn Ecoff; Shuko Nojiri; Shinji Mine; Yong-You Wu; Tetsu Fukunaga

doi:10.4240/wjgs.v17.i6.104333

Predictive model and prognostic insights into duodenal stump fistula following radical gastrectomy with Roux-en-Y reconstruction for gastric cancer

World J Gastrointest Surg. 2025 Jun 27;17(6):104333. doi: 10.4240/wjgs.v17.i6.104333.

Authors

Yang Yu^{1

2}, Suguru Yamauchi^{1

3}, Sanae Kaji¹, Yukinori Yube¹, Motomi Nasu¹, Yutaro Yoshimoto¹, Ming Cheng^{1

4}, Asako Ozaki¹, Takehiro Watanabe¹, Hajime Orita¹, Kaitlyn Ecoff³, Shuko Nojiri⁵, Shinji Mine¹, Yong-You Wu^{1

4}, Tetsu Fukunaga⁶

Affiliations

¹ Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan.
² Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing 100142, China.
³ Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, United States.
⁴ Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China.
⁵ Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan.
⁶ Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan. t2fukunaga@gmail.com.

Abstract

Background: Duodenal stump fistula (DSF) is a rare yet serious complication following gastric cancer surgery. The risk factors associated with DSF, as well as the predictive models, remain insufficiently elucidated.

Aim: To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis, develop a predictive model, and evaluate impact on prognosis.

Methods: This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021 (n = 325). Univariate and multivariate analyses were performed to identify the risk factors associated with DSF. Based on the independent risk factors, a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis. Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).

Results: Among the 325 patients analyzed, DSF was observed in 7 (2.2%) cases. No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used. Multivariate analysis confirmed that age [odds ratio (OR) = 1.17, P = 0.015] and obstructive ventilatory failure (OVF) (OR = 14.03, P = 0.001) were independent risk factors for DSF. The predictive nomogram was constructed based on age and OVF, which exhibited strong performance (area under the curve = 0.90, 95% confidence interval: 0.82-0.99). Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF, whereas no significant differences were observed in OS or DFS.

Conclusion: Age and OVF are independent risk factors for DSF, which worsens CSS. A nomogram predicts DSF accurately, and innovative surgical techniques may reduce its occurrence.

Keywords: Cancer survival; Duodenal stump fistula; Gastric cancer; Predictive nomogram; Roux-en-Y reconstruction.