title: Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management.
abstract: OBJECTIVE
  A duodenal stump fistula is one of the most severe complications after gastrectomy for gastric cancer. We aimed to analyze the risk factors for this problem, and to identify the methods used for its prevention and management.
  
  
  METHODS
  We retrospectively reviewed the clinical data of 716 consecutive patients who underwent curative gastrectomy with a duodenal stump for gastric cancer between 2008 and 2013.
  
  
  RESULTS
  A duodenal stump fistula occurred in 16 patients (2.2%) and there were 2 deaths in this group. Univariate analysis revealed age >60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 0.99-9.66), multiple comorbidities (OR, 4.23; 95% CI, 1.50-11.92), clinical T stage (OR, 2.91; 95% CI, 1.045-8.10), and gastric outlet obstruction (OR, 8.64; 95% CI, 2.61-28.61) to be significant factors for developing a duodenal stump fistula. Multivariate analysis identified multiple comorbidities (OR, 3.92; 95% CI, 1.30-11.80) and gastric outlet obstruction (OR, 5.62; 95% CI, 1.45-21.71) as predictors of this complication.
  
  
  CONCLUSIONS
  Multiple comorbidities and gastric outlet obstruction were the main risk factors for a duodenal stump fistula. Therefore, preventive methods and aggressive management should be applied for patients at high risk.
authors.affiliation: Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyun-June
authors.initials: HJ
authors.lastname: Paik
authors.affiliation: Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Si-Hak
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Chang-In
authors.initials: CI
authors.lastname: Choi
authors.affiliation: Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Dae-Hwan
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Jeon
authors.affiliation: Department of Surgery, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Dong-Heon
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Ung-Bae
authors.initials: UB
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Cheol-Woong
authors.initials: CW
authors.lastname: Choi
authors.affiliation: Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Sun-Hwi
authors.initials: SH
authors.lastname: Hwang
keywords: Complication; Gastrectomy; Gastric neoplasms; Intestinal fistula