Standard reporting on duodenal stump leakage after gastric cancer resections: multicentre analysis from the GASTRODATA Study Group (the STARDUST study)

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BACKGROUND: Gastric cancer surgery has historically implied significant levels of clinical burden and mortality. Postoperative duodenal stump leakage (DSL) represents a leading cause of postoperative mortality, but international occurrence rates and treatment strategy are lacking. The aim of this multinational retrospective cohort study was to evaluate the occurrence rate and treatment strategy factors for duodenal stump leakage after gastrectomy for cancer. METHODS: This retrospective multinational multicentre cohort study (the STARDUST study) retrospectively analysed a consecutive series of gastric cancer patients who underwent gastrectomy from 2019 to 2022 at 24 high-volume European members of the GASTRODATA registry. The primary outcomes included postoperative incidence and 90-day mortality after DSL. Secondary outcomes were clinical presentation, perioperative determinants, and complication treatment. RESULTS: A total of 2558 consecutive gastric cancer patients were identified from the registry and 2422 were eligible for the study. DSL occurred in 2.6% (64 of 2422) of the patients with a subsequent 90-day mortality rate of 17.2% (11 of 64). Conservative treatment was used for nine patients, followed by successful recovery without readmission. Interventional radiology was used for 16 patients (treatment success rate of 75%), while 39 patients required reoperation for acute presentation or failure of conservative options (treatment success rate of 74.4%). Multivariate analysis identified statistically significant independent prognostic factors for DSL, including preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion. CONCLUSION: Postoperative DSL was uncommon (2.6%), but it was associated with a 90-day mortality rate of 17.2%, which varied according to the severity of the clinical presentation and the invasiveness of the treatment. Preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion were prognostic factors associated with complication occurrence. The results need to be validated and prospectively endorsed within a standardized protocol guiding the intraoperative management of the duodenal stump and the choice of complication treatment.

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