Advance on prevention of duodenal stump leakage after laparoscopic radical gastrectomy for gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Luyao ^1,2 , LIU Jixiang ^2,3 , TANG Yufan ^2,4 , ZHOU Baiquan ^2,4 , WEN Bingbing ^2,3 , JIA Jiajia ^2,4 , SHA Ying ^2,3 , YU Ke ^2,4 ,  FAN Ruifang ^1,2

1. The Second Clinical Medical College of Lanzhou University, Lanzhou 730030, P. R. China;
2. Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, P. R. China;
3. Medicine Department of Northwest Minzu University, Lanzhou 730030, P. R. China;
4. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou 730030, P. R. China;

Corresponding?author：

FAN Ruifang, Email: fanruif@163.com

Keywords：

gastric cancer; laparoscopic radical gastrectomy; duodenal stump leakage; duodenal stump reinforcement; prevention

DOI：

10.7507/1007-9424.202408104

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To recognize the recent research progress in the prevention of duodenal stump leakage (DSL) after laparoscopic radical gastrectomy (LRG) for gastric cancer, so as to find a new breakthrough for reducing the occurrence of DSL. Method A review was conducted by searching recent domestic and international literature on the prevention and management of DSL after LRG for gastric cancer. Results At present, the risk factors of DSL after LRG were generally recognized in the literature, including relevant patients’ factors and surgery factors. The relevant factors of the patients themselves mainly were old age, malnutrition, and basic diseases; The factors relevant surgery mainly included surgical instruments, doctors’ operation level, etc. According to the literature, the measures taken for relevant patients’ factors mainly included preoperative improvement of nutritional status and control of the basic diseases; The preventive measures adopted for the relevant operation factors mainly included carefully intraoperative operation, improving of the anastomosis skills, and tacit cooperation of the team, which could reduce the occurrence of DSL. There was still controversy about the effect and method of routine duodenal stump reinforcement during operation. Conclusions The focus of reducing the occurrence of DSL is prevention. In clinical practice, patients with high-risk factors should receive special attention, with efforts to improve their condition, implement individualized decision-making, and perform meticulous intraoperative techniques to minimize complications, promote rapidly postoperative recovery, and maximize patients benefits.

Citation： LI Luyao, LIU Jixiang, TANG Yufan, ZHOU Baiquan, WEN Bingbing, JIA Jiajia, SHA Ying, YU Ke, FAN Ruifang. Advance on prevention of duodenal stump leakage after laparoscopic radical gastrectomy for gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 252-257. doi: 10.7507/1007-9424.202408104 Copy

1.	李茁鈺, 劉凱, 張維漢, 等. 全球及中國胃癌的流行病學特點及趨勢: 2018–2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(10): 1236-1245.
2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3.	中國抗癌協會胃癌專業委員會. 胃癌診治難點中國專家共識(2020版). 中國實用外科雜志, 2020, 40(8): 869-904.
4.	Gu L, Zhang K, Shen Z, et al. Risk factors for duodenal stump leakage after laparoscopic gastrectomy for gastric cancer. J Gastric Cancer, 2020, 20(1): 81-94.
5.	Po Chu Patricia Y, Ka Fai Kevin W, Fong Yee L, et al. Duodenal stump leakage. Lessons to learn from a large-scale 15-year cohort study. Am J Surg, 2020, 220(4): 976-981.
6.	馬軍, 周潮平, 張亞銘, 等. 胃癌根治術后早期嚴重并發癥的危險因素以及對遠期預后的影響. 國際外科學雜志, 2022, 49(2): 79-85, F3.
7.	Xia X, Zhang Z, Zhu C, et al. Neutrophil extracellular traps promote metastasis in gastric cancer patients with postoperative abdominal infectious complications. Nat Commun, 2022, 13(1): 1017. doi: 10.1038/s41467-022-28492-5.
8.	Zizzo M, Ugoletti L, Manzini L, et al. Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature. BMC Surg, 2019, 19(1): 55. doi: 10.1186/s12893-019-0520-x.
9.	Katai H, Mizusawa J, Katayama H, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage ⅠA or ⅠB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol, 2020, 5(2): 142-151.
10.	胡祥. 第6版日本《胃癌治療指南》拔萃. 中國實用外科雜志, 2021, 41(10): 1130-1141.
11.	Cozzaglio L, Giovenzana M, Biffi R, et al. Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study. Gastric Cancer, 2016, 19(1): 273-279.
12.	Paik HJ, Lee SH, Choi CI, et al. Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management. Ann Surg Treat Res, 2016, 90(3): 157-163.
13.	Ali BI, Park CH, Song KY. Outcomes of non-operative treatment for duodenal stump leakage after gastrectomy in patients with gastric cancer. J Gastric Cancer, 2016, 16(1): 28-33.
14.	孫占彬. 胃癌術后發生十二指腸殘端瘺的相關因素研究. 中國基層醫藥, 2017, 24(22): 3493-3496.
15.	劉狀. 胃術后十二指腸殘端瘺發生的危險因素分析. 長春: 吉林大學, 2024.
16.	張康, 顧利虎, 莫宇軒, 等. 腹腔鏡胃癌根治術術后十二指腸殘端瘺的危險因素分析. 嶺南現代臨床外科, 2020, 20(1): 1-7.
17.	Ramos MFKP, Pereira MA, et al. Duodenal fistula: The most lethal surgical complication in a case series of radical gastrectomy. Int J Surg, 2018, 53: 366-370.
18.	Yu H, Xu L, Yin S, et al. Risk factors and prognostic impact of postoperative complications in patients with advanced gastric cancer receiving neoadjuvant chemotherapy. Curr Oncol, 2022, 29(9): 6496-6507.
19.	Iwasaki Y, Terashima M, Mizusawa J, et al. Gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer (JCOG0501): an open-label, phase 3, randomized controlled trial. Gastric Cancer, 2021, 24(2): 492-502.
20.	Cui H, Cui JX, Wang YN, et al. Could neoadjuvant chemotherapy increase postoperative complication risk of laparoscopic total gastrectomy? A mono-institutional propensity score-matched study in China. World J Gastrointest Surg, 2021, 13(5): 429-442.
21.	中國腹腔鏡胃腸外科研究組(CLASS研究組), 中華醫學會外科學分會腹腔鏡與內鏡外科學組, 中華醫學會外科學分會胃腸外科學組. 腹腔鏡胃癌手術患者使用口服營養補充的專家共識(2020版). 中華胃腸外科雜志, 2020, 23(7): 623-628.
22.	張鵬, 蘭天珩, 周一鳴, 等. 胃癌根治術圍手術期并發癥危險因素分析. 中華胃腸外科雜志, 2019, 22(8): 736-741.
23.	舒旭峰. 腹腔鏡胃癌根治術后十二指腸殘端瘺危險因素分析及Nomogram預測模型建立. 南昌: 南昌大學, 2022.
24.	Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
25.	中華醫學會外科學分會腹腔鏡與內鏡外科學組, 中國研究型醫院學會機器人與腹腔鏡外科專業委員會, 中國抗癌協會腔鏡與機器人外科分會, 等. 腹腔鏡胃癌手術操作指南(2023版). 中國實用外科雜志, 2023, 43(4): 361-370.
26.	Chen X, Feng X, Wang M, et al. Laparoscopic versus open distal gastrectomy for advanced gastric cancer: A meta-analysis of randomized controlled trials and high-quality nonrandomized comparative studies. Eur J Surg Oncol, 2020, 46(11): 1998-2010.
27.	Beyer K, Baukloh AK, Kamphues C, et al. Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol, 2019, 17(1): 68. doi: 10.1186/s12957-019-1600-1.
28.	Aiolfi A, Lombardo F, Matsushima K, et al. Systematic review and updated network meta-analysis of randomized controlled trials comparing open, laparoscopic-assisted, and robotic distal gastrectomy for early and locally advanced gastric cancer. Surgery, 2021, 170(3): 942-951.
29.	Huang C, Liu H, Hu Y, et al. Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: Five-year outcomes from the CLASS-01 randomized clinical trial. JAMA Surg, 2022, 157(1): 9-17.
30.	Liu F, Huang C, Xu Z, et al. Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage Ⅰ gastric cancer: The CLASS02 multicenter randomized clinical trial. JAMA Oncol, 2020, 6(10): 1590-1597.
31.	中國抗癌協會胃癌專業委員會, 中華醫學會外科學分會胃腸外科學組, 中國醫師協會外科醫師分會上消化道專業委員會, 等. 腹腔鏡胃癌根治術消化道重建相關并發癥防治中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(8): 659-668.
32.	鄧春, 張偉, 吳興康, 等. 完全腹腔鏡全胃切除術中亞甲藍檢查預防術后吻合技術缺陷相關的吻合口漏. 中華普通外科雜志, 2021, 36(10): 782-783.
33.	無. 胃癌根治術中十二指腸殘端加固縫合問題. 中國實用外科雜志, 2017, 37(4): 386-387.
34.	中華醫學會外科學分會. 腹腔鏡胃外科手術縫合技術與縫合材料選擇中國專家共識(2021版). 中國實用外科雜志, 2021, 41(5): 495-503.
35.	He H, Li H, Ye B, et al. Single purse-string suture for reinforcement of duodenal stump during laparoscopic radical gastrectomy for gastric cancer. Front Oncol, 2019, 9: 1020. doi: 10.3389/fonc.2019.01020.
36.	馮樹森, 張東成, 郭奇. 連續全層加固縫合十二指腸殘端方案在胃癌根治術中的應用及生存質量分析. 河北醫學, 2023, 29(3): 451-456.
37.	賀宏勇, 席艷峰, 李豪杰, 等. 腹腔鏡胃癌根治術十二指腸殘端采用單荷包縫合加固的療效觀察. 中華胃腸外科雜志, 2019, 22(8): 762-766.
38.	楊斌, 張志平, 殷永芳, 等. 腹腔鏡胃癌根治術應用倒刺線對十二指腸殘端行雙半小荷包加連續縫合包埋的療效觀察. 中華普通外科雜志, 2022, 37(2): 127-128.
39.	Sano A, Imai Y, Yamaguchi T, et al. Importance of duodenal stump reinforcement to prevent stump leakage after gastrectomy: a large-scale multicenter retrospective study (KSCC DELICATE study). Gastric Cancer, 2024, 27(6): 1320-1330.
40.	Ri M, Hiki N, Ishizuka N, et al. Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer. Gastric Cancer, 2019, 22(5): 1053-1059.
41.	Sun L, Wang W, Zhou J, et al. Modified Q-type purse-string suture duodenal stump embedding method for laparoscopic gastrectomy for gastric cancer. BMC Surg, 2024, 24(1): 123. doi: 10.1186/s12893-024-02423-1.
42.	Wang Q, Wang Z, Jin S, et al. Double half purse-string sutures plus “8” pattern of stitching for prevention of duodenal stump fistula after laparoscopic gastrectomy. J Laparoendosc Adv Surg Tech A, 2024, 34(9): 814-821.
43.	Misawa K, Yoshikawa T, Ito S, et al. Safety and feasibility of linear stapling device with bioabsorbable polyglycolic acid sheet for duodenal closure in gastric cancer surgery: A multi-institutional phase Ⅱ study. World J Surg, 2019, 43(1): 192-198.
44.	Chung JH, Choi CW, Kim SJ, et al. Application of the falciform ligament patch for the prevention of duodenal stump leakage after gastrectomy: Technical report on a case series. J Laparoendosc Adv Surg Tech A, 2023, 33(5): 447-451.
45.	燕明, 李政焰, 林夏, 等. 十二指腸殘端加固對腹腔鏡胃癌根治術患者術后并發癥的影響. 中華胃腸外科雜志, 2022, 25(7): 590-595.
46.	Du J, Xue H, Zhao L, et al. Handover method: Simple, classic and harmonized intracorporeal closure of stapled duodenal stump during laparoscopic gastrectomy. J Surg Oncol, 2021, 124(1): 41-48.

1. 李茁鈺, 劉凱, 張維漢, 等. 全球及中國胃癌的流行病學特點及趨勢: 2018–2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(10): 1236-1245.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3. 中國抗癌協會胃癌專業委員會. 胃癌診治難點中國專家共識(2020版). 中國實用外科雜志, 2020, 40(8): 869-904.
4. Gu L, Zhang K, Shen Z, et al. Risk factors for duodenal stump leakage after laparoscopic gastrectomy for gastric cancer. J Gastric Cancer, 2020, 20(1): 81-94.
5. Po Chu Patricia Y, Ka Fai Kevin W, Fong Yee L, et al. Duodenal stump leakage. Lessons to learn from a large-scale 15-year cohort study. Am J Surg, 2020, 220(4): 976-981.
6. 馬軍, 周潮平, 張亞銘, 等. 胃癌根治術后早期嚴重并發癥的危險因素以及對遠期預后的影響. 國際外科學雜志, 2022, 49(2): 79-85, F3.
7. Xia X, Zhang Z, Zhu C, et al. Neutrophil extracellular traps promote metastasis in gastric cancer patients with postoperative abdominal infectious complications. Nat Commun, 2022, 13(1): 1017. doi: 10.1038/s41467-022-28492-5.
8. Zizzo M, Ugoletti L, Manzini L, et al. Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature. BMC Surg, 2019, 19(1): 55. doi: 10.1186/s12893-019-0520-x.
9. Katai H, Mizusawa J, Katayama H, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage ⅠA or ⅠB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol, 2020, 5(2): 142-151.
10. 胡祥. 第6版日本《胃癌治療指南》拔萃. 中國實用外科雜志, 2021, 41(10): 1130-1141.
11. Cozzaglio L, Giovenzana M, Biffi R, et al. Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study. Gastric Cancer, 2016, 19(1): 273-279.
12. Paik HJ, Lee SH, Choi CI, et al. Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management. Ann Surg Treat Res, 2016, 90(3): 157-163.
13. Ali BI, Park CH, Song KY. Outcomes of non-operative treatment for duodenal stump leakage after gastrectomy in patients with gastric cancer. J Gastric Cancer, 2016, 16(1): 28-33.
14. 孫占彬. 胃癌術后發生十二指腸殘端瘺的相關因素研究. 中國基層醫藥, 2017, 24(22): 3493-3496.
15. 劉狀. 胃術后十二指腸殘端瘺發生的危險因素分析. 長春: 吉林大學, 2024.
16. 張康, 顧利虎, 莫宇軒, 等. 腹腔鏡胃癌根治術術后十二指腸殘端瘺的危險因素分析. 嶺南現代臨床外科, 2020, 20(1): 1-7.
17. Ramos MFKP, Pereira MA, et al. Duodenal fistula: The most lethal surgical complication in a case series of radical gastrectomy. Int J Surg, 2018, 53: 366-370.
18. Yu H, Xu L, Yin S, et al. Risk factors and prognostic impact of postoperative complications in patients with advanced gastric cancer receiving neoadjuvant chemotherapy. Curr Oncol, 2022, 29(9): 6496-6507.
19. Iwasaki Y, Terashima M, Mizusawa J, et al. Gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer (JCOG0501): an open-label, phase 3, randomized controlled trial. Gastric Cancer, 2021, 24(2): 492-502.
20. Cui H, Cui JX, Wang YN, et al. Could neoadjuvant chemotherapy increase postoperative complication risk of laparoscopic total gastrectomy? A mono-institutional propensity score-matched study in China. World J Gastrointest Surg, 2021, 13(5): 429-442.
21. 中國腹腔鏡胃腸外科研究組(CLASS研究組), 中華醫學會外科學分會腹腔鏡與內鏡外科學組, 中華醫學會外科學分會胃腸外科學組. 腹腔鏡胃癌手術患者使用口服營養補充的專家共識(2020版). 中華胃腸外科雜志, 2020, 23(7): 623-628.
22. 張鵬, 蘭天珩, 周一鳴, 等. 胃癌根治術圍手術期并發癥危險因素分析. 中華胃腸外科雜志, 2019, 22(8): 736-741.
23. 舒旭峰. 腹腔鏡胃癌根治術后十二指腸殘端瘺危險因素分析及Nomogram預測模型建立. 南昌: 南昌大學, 2022.
24. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
25. 中華醫學會外科學分會腹腔鏡與內鏡外科學組, 中國研究型醫院學會機器人與腹腔鏡外科專業委員會, 中國抗癌協會腔鏡與機器人外科分會, 等. 腹腔鏡胃癌手術操作指南(2023版). 中國實用外科雜志, 2023, 43(4): 361-370.
26. Chen X, Feng X, Wang M, et al. Laparoscopic versus open distal gastrectomy for advanced gastric cancer: A meta-analysis of randomized controlled trials and high-quality nonrandomized comparative studies. Eur J Surg Oncol, 2020, 46(11): 1998-2010.
27. Beyer K, Baukloh AK, Kamphues C, et al. Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol, 2019, 17(1): 68. doi: 10.1186/s12957-019-1600-1.
28. Aiolfi A, Lombardo F, Matsushima K, et al. Systematic review and updated network meta-analysis of randomized controlled trials comparing open, laparoscopic-assisted, and robotic distal gastrectomy for early and locally advanced gastric cancer. Surgery, 2021, 170(3): 942-951.
29. Huang C, Liu H, Hu Y, et al. Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: Five-year outcomes from the CLASS-01 randomized clinical trial. JAMA Surg, 2022, 157(1): 9-17.
30. Liu F, Huang C, Xu Z, et al. Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage Ⅰ gastric cancer: The CLASS02 multicenter randomized clinical trial. JAMA Oncol, 2020, 6(10): 1590-1597.
31. 中國抗癌協會胃癌專業委員會, 中華醫學會外科學分會胃腸外科學組, 中國醫師協會外科醫師分會上消化道專業委員會, 等. 腹腔鏡胃癌根治術消化道重建相關并發癥防治中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(8): 659-668.
32. 鄧春, 張偉, 吳興康, 等. 完全腹腔鏡全胃切除術中亞甲藍檢查預防術后吻合技術缺陷相關的吻合口漏. 中華普通外科雜志, 2021, 36(10): 782-783.
33. 無. 胃癌根治術中十二指腸殘端加固縫合問題. 中國實用外科雜志, 2017, 37(4): 386-387.
34. 中華醫學會外科學分會. 腹腔鏡胃外科手術縫合技術與縫合材料選擇中國專家共識(2021版). 中國實用外科雜志, 2021, 41(5): 495-503.
35. He H, Li H, Ye B, et al. Single purse-string suture for reinforcement of duodenal stump during laparoscopic radical gastrectomy for gastric cancer. Front Oncol, 2019, 9: 1020. doi: 10.3389/fonc.2019.01020.
36. 馮樹森, 張東成, 郭奇. 連續全層加固縫合十二指腸殘端方案在胃癌根治術中的應用及生存質量分析. 河北醫學, 2023, 29(3): 451-456.
37. 賀宏勇, 席艷峰, 李豪杰, 等. 腹腔鏡胃癌根治術十二指腸殘端采用單荷包縫合加固的療效觀察. 中華胃腸外科雜志, 2019, 22(8): 762-766.
38. 楊斌, 張志平, 殷永芳, 等. 腹腔鏡胃癌根治術應用倒刺線對十二指腸殘端行雙半小荷包加連續縫合包埋的療效觀察. 中華普通外科雜志, 2022, 37(2): 127-128.
39. Sano A, Imai Y, Yamaguchi T, et al. Importance of duodenal stump reinforcement to prevent stump leakage after gastrectomy: a large-scale multicenter retrospective study (KSCC DELICATE study). Gastric Cancer, 2024, 27(6): 1320-1330.
40. Ri M, Hiki N, Ishizuka N, et al. Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer. Gastric Cancer, 2019, 22(5): 1053-1059.
41. Sun L, Wang W, Zhou J, et al. Modified Q-type purse-string suture duodenal stump embedding method for laparoscopic gastrectomy for gastric cancer. BMC Surg, 2024, 24(1): 123. doi: 10.1186/s12893-024-02423-1.
42. Wang Q, Wang Z, Jin S, et al. Double half purse-string sutures plus “8” pattern of stitching for prevention of duodenal stump fistula after laparoscopic gastrectomy. J Laparoendosc Adv Surg Tech A, 2024, 34(9): 814-821.
43. Misawa K, Yoshikawa T, Ito S, et al. Safety and feasibility of linear stapling device with bioabsorbable polyglycolic acid sheet for duodenal closure in gastric cancer surgery: A multi-institutional phase Ⅱ study. World J Surg, 2019, 43(1): 192-198.
44. Chung JH, Choi CW, Kim SJ, et al. Application of the falciform ligament patch for the prevention of duodenal stump leakage after gastrectomy: Technical report on a case series. J Laparoendosc Adv Surg Tech A, 2023, 33(5): 447-451.
45. 燕明, 李政焰, 林夏, 等. 十二指腸殘端加固對腹腔鏡胃癌根治術患者術后并發癥的影響. 中華胃腸外科雜志, 2022, 25(7): 590-595.
46. Du J, Xue H, Zhao L, et al. Handover method: Simple, classic and harmonized intracorporeal closure of stapled duodenal stump during laparoscopic gastrectomy. J Surg Oncol, 2021, 124(1): 41-48.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advance on prevention of duodenal stump leakage after laparoscopic radical gastrectomy for gastric cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content