Duodenal fistula after elective gastrectomy for malignant disease : an italian retrospective multicenter study.
BACKGROUND
Duodenal fistula (DF) after gastrectomy continues to be a life-threatening problem. We performed a retrospective multicenter study analyzing the characteristics of DF after elective gastrectomy for malignant disease.


METHODS
Three thousand seven hundred eighty-five patients who had undergone gastrectomy with duodenal stump in 11 Italian surgical units were analyzed.


RESULTS
Sixty-eight DFs occurred, with a median frequency of 1.6% and a mortality rate of 16%. Complications were mainly septic but fistulas or bleeding of surrounding organs accounted for about 30%. Reoperation was performed in 40% of patients. We observed a correlation between mortality and age (hazard ratio 1.09; 95% CI 1.00-1.20) and serum albumin (hazard ratio 0.90; 95% CI 0.83-0.99). The appearance of further complications was associated with reoperation (P < 0.001) and death (P = 0.054), while the preservation of oral feeding was related to DF healing (P < 0.001).


CONCLUSIONS
This paper represents the largest series ever published on DF and shows that its features have changed in the last 20 years. DF alone no longer leads to death and some complications observed in the past have disappeared, while new ones are emerging. Nowadays, medical therapy is preferred and surgery is indicated only in cases of abdominal sepsis or bleeding.
Division of Surgical Oncology, IRCCS Istituto Clinico Humanitas, via Manzoni 56, 20089 Rozzano, MI, Italy. luca.cozzaglio@humanitas.it
Luca
L
Cozzaglio
Massimiliano
M
Coladonato
Roberto
R
Biffi
Arianna
A
Coniglio
Vittorio
V
Corso
Paolo
P
Dionigi
Luca
L
Gianotti
Vincenzo
V
Mazzaferro
Paolo
P
Morgagni
Fausto
F
Rosa
Riccardo
R
Rosati
Francesco
F
Roviello
Roberto
R
Doci
D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D004378:Duodenal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome