Analysis of risk factors for postoperative duodenal stump fistula in elderly patients with gastric cancer / 国际肿瘤学杂志

ABSTRACT

Objective To investigate the risk factors for the occurrence of duodenal stump fistula in elderly patients with gastric cancer after radical resection.Methods From June 1996 to June 2016,the clinical data of 560 patients underwent radical operation for gastric cancer in elderly patients (age ≥ 60) in the Fifth People's Hospital of Zhangjiagang of Jiangsu Province and 254 Hospital of PLA were collected.They were divided into occurred group (n =30) and without occurred group (n =530) according to whether duodenal stump fistula occurred or not.The effects of operative factors and nonoperative factors on duodenal fistula were analyzed.Nonoperative factors included gender,preoperative hemoglobin,preoperative serum albumin level,basic diseases (hypertension,diabetes,chronic obstructive pulmonary disease,heart disease,liver cirrhosis)and tumor staging;operative factors included operation time,intraoperative blood loss,surgical approach,reconstruction of digestive tract and duodenal stump embedding,etc.Results Single factor analysis showed that the preoperative serum albumin level (t =-5.035,P ＜ 0.001),preoperative hemoglobin (t =-0.567,P =0.048) and combined liver cirrhosis (x2 =14.093,P ＜ 0.001) of nonoperative factors were associated with the occurrence of duodenal stump fistula after surgery;reconstruction of digestive tract (x2 =5.427,P =0.019),and duodenal stump embedding (x2 =13.378,P ＜ 0.001) of operative factors were associated with the occurrence of duodenal stump fistula after surgery.Multivariate logstic analysis of regression showed that preoperative serum albumin level (OR =5.214,95 ％ CI2.230-12.172,P =0.032),combined liver cirrhosis (OR =4.885,95％ CI3.805-6.259,P =0.021),and reconstruction of digestive tract (OR=3.779,95％ CI2.148-6.617,P ＜ 0.001) were independent risk factors affecting the occurrence of duodenal stump fistula after surgery.Conclusion Preoperative albumin level,combined liver cirrhosis and reconstruction of digestive tract are the main risk factors for postoperative duodenal stump fistula in elderly patients with gastric cancer.