When doctors remove a stomach to treat cancer, sometimes the connection they create leaks fluid. Researchers looked at 162 patients from 9 hospitals in Korea who had this complication between 2003 and 2024. They found that using a camera to fix the leak from the inside (endoscopic therapy) worked better than reopening the patient for surgery. This newer approach helped patients recover faster, eat sooner, and go home quicker. The study shows that doctors are moving away from traditional surgery toward these less invasive camera-based treatments, which appear to be safer and more effective.

The Quick Take

  • What they studied: How doctors treat leaks that happen when the small intestine is connected to the esophagus (food pipe) after removing a stomach for cancer treatment
  • Who participated: 162 patients from 9 Korean hospitals who developed this complication between 2003 and 2024. About 3% of the 6,577 total patients who had stomach removal surgery developed this leak
  • Key finding: Camera-based treatment (endoscopic therapy) worked successfully in 94.3% of cases, which was significantly better than reopening patients for surgery. Patients treated with the camera method recovered faster and went home sooner
  • What it means for you: If you or a loved one needs stomach removal surgery for cancer, knowing that doctors now have a better, less invasive way to handle complications may reduce worry. However, this research is specific to this particular complication and doesn’t change the need for careful post-surgery monitoring

The Research Details

Researchers looked back at medical records from 9 hospitals in Korea over 21 years (2003-2024). They identified all patients who had their entire stomach removed for cancer treatment and developed a leak where the small intestine connects to the food pipe. They organized patients into four groups based on how doctors treated the leak: doing nothing but monitoring (conservative), using a camera to fix it (endoscopic), reopening the patient for surgery (reoperation), or combining multiple approaches. They then compared how well each treatment worked and how quickly patients recovered.

This type of study is called a retrospective cohort study, meaning researchers looked backward at what already happened rather than following patients forward in time. The researchers collected information about when the leak was discovered, how it was treated, whether the treatment worked, and how long patients stayed in the hospital.

This research matters because stomach removal surgery is a major operation, and leaks at the connection point are serious complications that can be life-threatening. Understanding which treatment methods work best helps doctors make better decisions about how to help patients. By tracking changes over 21 years, the study shows how medical practice has evolved and improved, which is important for hospitals deciding what equipment and training they need.

This study has good strengths: it includes a large number of patients (162 with complete information) from multiple hospitals, which makes the findings more reliable than a single hospital’s experience. The long time period (21 years) shows real changes in how doctors practice. However, because it looks backward at existing records rather than following patients forward, some information may be missing or recorded differently at different hospitals. The study doesn’t explain why some doctors chose one treatment over another, which could affect the results. The overall number of patients with this complication is relatively small (3%), so the findings apply to a specific situation

What the Results Show

Among 162 patients who developed a leak after stomach removal surgery, doctors used four different treatment approaches. The camera-based treatment (endoscopic therapy) was the most successful, working in 94.3% of cases. This was significantly better than the other methods tested. Importantly, the camera method became more popular over time—it was first used in 2011 and by the end of the study period was being used in about one-third of cases.

Patients treated with the camera method recovered much faster than those who needed reoperation (another surgery). They could start eating again sooner and left the hospital earlier. For example, patients in the camera group and those managed conservatively (just monitored) spent less time in the hospital compared to those who needed surgery or combined treatments.

The leak was typically discovered about 8.4 days after the initial stomach removal surgery. Overall, 6.1% of patients (10 out of 162) died while in the hospital, though the study doesn’t clearly explain which treatment groups had better survival rates. The shift toward camera-based treatment over the 21-year period suggests that hospitals learned this method works better and became more skilled at using it.

The study found that how quickly patients could resume eating was an important marker of recovery. Patients treated with the camera method or conservative management (careful monitoring without intervention) could eat again much sooner than those requiring surgery. This faster return to eating likely helps patients regain strength and leave the hospital sooner. The study also noted that the average time from surgery to discovering the leak was about 8.4 days, which helps doctors know when to watch most carefully for this complication. The research showed that treatment approaches changed significantly over the 21-year period, with hospitals increasingly choosing the camera method as they gained experience and confidence with it.

This research builds on earlier knowledge that leaks after stomach removal are serious but treatable complications. Previous studies suggested that reoperation (opening the patient again for surgery) was the traditional approach, but it carried significant risks and longer recovery times. This study confirms what some earlier research hinted at: that camera-based treatment (endoscopic therapy) is becoming the preferred method. The shift from surgery-based treatment to camera-based treatment mirrors changes happening in other areas of surgery, where doctors increasingly prefer less invasive approaches when they work well. This study provides strong evidence that the shift toward camera methods is justified by better outcomes.

The study has several important limitations. Because researchers looked backward at existing medical records rather than planning the study in advance, some information may be incomplete or recorded differently at different hospitals. The study doesn’t explain why doctors chose different treatments for different patients—some patients may have been sicker or had other conditions that influenced treatment choice, which could affect the results. The study doesn’t clearly separate which patients survived and which didn’t by treatment type, making it hard to know if one method was safer than others. The research is specific to Korean hospitals and may not apply exactly the same way in other countries with different medical practices. Finally, the study doesn’t include information about long-term quality of life or complications that might appear months or years later

The Bottom Line

For patients facing stomach removal surgery for cancer: Ask your surgical team about their experience with handling leaks and whether they can use camera-based treatment if needed. This appears to be the most effective approach based on current evidence. For hospitals and surgeons: Consider adopting or improving endoscopic (camera-based) treatment capabilities, as this research shows it produces better outcomes than traditional reoperation. Confidence level: Moderate to High for this specific complication, though the overall number of patients affected is small

This research is most relevant to: patients with gastric (stomach) cancer who will have their stomach removed, their families, and their surgical teams. It’s also important for hospital administrators deciding what equipment and training to invest in. This research does NOT apply to other types of stomach surgery or other types of leaks. It’s specific to a particular surgical complication that occurs in about 3% of stomach removal cases

If this complication occurs, it typically appears within about 8 days after surgery. With camera-based treatment, patients who respond well may resume eating within days to weeks and go home within 1-2 weeks. However, recovery varies by individual, and some patients may need longer hospitalization or additional treatments. Long-term recovery to normal eating and activity typically takes several weeks to months

Want to Apply This Research?

  • If you’re recovering from stomach removal surgery, track daily: (1) ability to eat and drink (note what you can tolerate), (2) any signs of complications like fever, severe pain, or vomiting, and (3) energy levels. This helps you and your medical team monitor recovery progress
  • Work with your surgical team to create a post-surgery eating plan. Start with clear liquids, then progress to soft foods as tolerated. Use the app to log what you eat, how you feel afterward, and any symptoms. This creates a record to share with your doctor and helps identify any problems early
  • For the first 2-3 weeks after surgery, check in daily with your tracking. After that, weekly check-ins are usually sufficient. Continue tracking any unusual symptoms (fever, severe pain, vomiting, inability to keep food down) for at least 4 weeks. If you notice warning signs, contact your surgical team immediately rather than waiting for your next appointment

This research describes treatment for a specific surgical complication (esophagojejunostomy leakage) that occurs in about 3% of stomach removal surgeries for cancer. This information is educational and should not replace medical advice from your surgical team. If you have stomach cancer or are considering stomach removal surgery, discuss all treatment options, risks, and expected outcomes with your oncologist and surgeon. If you experience symptoms like fever, severe abdominal pain, vomiting, or inability to eat after stomach surgery, seek immediate medical attention. This study was conducted in Korean hospitals and may not reflect practices or outcomes in all healthcare settings.