Effect of food loop and duodenal stump fixation on clinical outcomes in patients undergoing radical gastrectomy with Roux-en-Y reconstruction for distal gastric cancer: a single-center propensity score matching analysis.

[OBJECTIVE] This study aimed to evaluate the safety and reliability of an innovative technique-fixation of the food loop and duodenal stump-by investigating its impact on postoperative complications and overall survival (OS) in patients undergoing distal gastrectomy with Roux-en-Y reconstruction.

[METHODS] A retrospective analysis was conducted on patients who underwent radical distal gastrectomy and Roux-en-Y reconstruction at Suzhou Ninth People's Hospital between January 2012 and December 2023. Patients were divided into with duodenum fixation and without duodenum fixation groups based on whether food loop and duodenal stump fixation was performed during surgery. Propensity score matching (PSM) was used to match 95 pairs of patients, and differences in baseline characteristics, postoperative complications, subgroup analysis, and survival outcomes were compared. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for postoperative complications.

[RESULTS] After PSM, there were no significant differences between the two groups in terms of baseline characteristics, operative time, estimated blood loss, time to first flatus, or postoperative length of hospital stay (P > 0.05). The overall incidence of postoperative complications showed no significant differences between the two groups (P > 0.05). The incidence of Roux-en-Y stasis syndrome (RSS) was significantly lower in the fixation group (P = 0.035). Subgroup analysis revealed that duodenal stump fixation had no significant effect on the overall incidence of postoperative complications across various subgroups (all P > 0.05). Survival analysis indicated that duodenal stump fixation had no significant effect on OS (P = 0.33).

[CONCLUSION] The novel technique of food loop and duodenal stump fixation significantly reduces the incidence of Roux-en-Y stasis syndrome without increasing the risk of postoperative complications or affecting long-term prognosis, demonstrating its safety and reliability in distal gastric cancer surgery.