Background/Objectives: Duodenal stump fistula (DSF) is one of the most feared postoperative complications in gastric cancer surgery. It has a 1.6–5% incidence rate and correlates with potentially high rates of morbidity (75%) and mortality (16–20%). The absence of duodenal stump reinforcement is considered one of the main risk factors. Our meta-analysis aimed to provide updated evidence by comparing DSF rates among patients who underwent distal or total gastrectomy for malignant gastric disease with or without reinforcement of the duodenal stump.Methods: We performed a systematic review following the PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library databases were used to identify articles of interest. Meta-analysis was performed by using RevMan Version 5.4.Results: The six included comparative studies (19,527 patients: 11,545 reinforcement group versus 7982 control group) covered an approximately 20-year study period (2005–2023). All the studies included were observational in nature. Meta-analysis of pooled results showed that, compared to the control group, the reinforcement group recorded a statistically significant lower DSF rate (OR: 0.32, 95% CI: 0.17, 0.60,p= 0.0004). Considering secondary outcomes, no statistically significant differences were identified between the two groups in terms of operative time, EBL, overall postoperative complications, and length of hospital stay. Just major postoperative complications were considerably lower in the reinforcement group compared to the control group (OR: 0.66, 95% CI: 0.43, 0.99,p= 0.04).Conclusions: Duodenal stump reinforcement appears to reduce the rate of DSF after distal or total gastrectomy for malignant gastric disease. Given the significant biases among meta-analyzed studies, our results require careful interpretation. Further randomized, possibly multicenter trials may turn out to be of paramount importance in confirming our results.
背景/目的：十二指肠残端瘘是胃癌手术中最令人担忧的术后并发症之一，其发生率为1.6–5%，并与较高的发病率（75%）和死亡率（16–20%）相关。未进行十二指肠残端加固被认为是主要风险因素之一。本荟萃分析旨在通过比较因恶性胃疾病接受远端或全胃切除术的患者中，无论是否进行十二指肠残端加固的DSF发生率，提供最新的证据。 方法：我们按照PRISMA指南进行了系统综述。使用PubMed/MEDLINE、Scopus、Web of Science、Embase和Cochrane Library数据库检索相关文献。使用RevMan 5.4版软件进行荟萃分析。 结果：纳入的六项比较研究（共19,527例患者：加固组11,545例 vs 对照组7,982例）覆盖了约20年的研究期（2005–2023年）。所有纳入研究均为观察性研究。汇总结果的荟萃分析显示，与对照组相比，加固组的DSF发生率显著降低（OR: 0.32, 95% CI: 0.17–0.60, p=0.0004）。在次要结局方面，两组在手术时间、估计失血量、总体术后并发症和住院时间方面均无统计学显著差异。仅术后主要并发症发生率在加固组显著低于对照组（OR: 0.66, 95% CI: 0.43–0.99, p=0.04）。 结论：十二指肠残端加固似乎能降低因恶性胃疾病行远端或全胃切除术后的DSF发生率。鉴于纳入研究存在显著偏倚，我们的结果需要谨慎解读。进一步的随机、可能多中心的试验对于证实我们的结果至关重要。
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