To evaluate the impact of duodenal stump management on postoperative complications in totally laparoscopic radical gastrectomy for gastric cancer.

A prospective observational cohort was established, including patients who underwent totally laparoscopic radical gastrectomy at the Cancer Hospital of the Chinese Academy of Medical Sciences from Dec. 2021 to Dec. 2022. The duodenum was transected using a linear cutting stapler, followed by Billroth Ⅱ or Roux-en-Y anastomosis. The duodenal stump was managed with continuous suturing using 3-0 absorbable barbed sutures. The primary outcome was the incidence of short-term postoperative complications, graded according to the Clavien-Dindo classification. Additionally, drainage fluid from the duodenal stump was collected on postoperative days 1, 3, 5, and 7 for total bilirubin and amylase testing.

A total of 134 patients were included in the study, with 63 patients undergoing duodenal stump reinforcement and 71 patients not receiving reinforcement. No significant differences were observed between the two groups in terms of age, sex, BMI, ECOG, NRS 2002, medical comorbidities, preoperative neoadjuvant therapy, and TNM stage. Both groups predominantly underwent Billroth Ⅱ anastomosis. There was no significant difference in operative time between the reinforcement group and the non-reinforcement group (160.7±38.2 min vs. 156.3±36.6 min, P=0.649). The overall complication rates and severe complication rates were not significantly different between the two groups, but the non-reinforcement group had two cases of duodenal stump fistula, whereas the reinforcement group had none. The median levels of total bilirubin and amylase in the drainage fluid were lower in the reinforcement group than in the non-reinforcement group on postoperative days 1, 3, 5, and 7, with a significant difference in total bilirubin on the first postoperative day.

Reinforcement of the duodenal stump in total laparoscopic radical gastrectomy for gastric cancer can effectively reduce the incidence of duodenal stump leakage.