[A novel treatment strategy using trafermin, containing basic fibroblast growth factor, for intractable duodenal fistula following curative gastrectomy for gastric cancer-case report and literature review]

Abstract

Despite recent perioperative technological advances in gastric cancer treatment, duodenal stump leakage and intractable duodenal fistula are still major critical complications following gastrectomy that should be specifically targeted in order to improve postoperative outcomes. Here, we provide a preliminary report of a case of intractable duodenal fistula successfully treated with Trafermin containing basic fibroblast growth factor. A 70-year-old man underwent distal gastrectomy with radical lymphadenectomy for early distal gastric cancer (pT1bN0M0). After surgery, duodenal fistula occurred and persisted for 1 year and 2 months despite surgery and several conservative treatments. After obtaining informed consent, we started injection of Trafermin at 50 μg/day through a drainage tube into the dehiscence of the duodenum. Consequently, the duodenal fistula was successfully closed within 4 weeks. Our novel treatment technique is simple, rapid, and cost effective. If informed consent is obtained from patients with a low risk of recurrence, this technique should be recommended as one of the treatment choices for intractable duodenal fistula following curative gastrectomy for gastric cancer.