A quantified risk‐scoring system and rating model for postsurgical gastroparesis syndrome in gastric cancer patients

Chen, Xiaodong; Mao, Chenchen; Zhang, Weiteng; Lin, Ji; Wu, Rui-sen; Zhang, Fengmin; Sun, Xia; Chi, Chu-huai; Shen, Xian; Wang, Pengfei

doi:10.1002/jso.24691

Cited by 15 publications

(13 citation statements)

References 29 publications

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“…The etiology of postsurgical gastroparesis syndrome (PGS) was diverse. Recent studies identified several risk factors for PGS, such as patient BMI ≥ 25 kg/m 2 , age ≥ 65 years, B-II reconstruction and the like [33, 35]. In the present study, PGS occurred in 16 patients in total.…”

Section: Discussionmentioning

confidence: 48%

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

et al. 2018

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BackgroundAlthough laparoscopic surgery has been recommended as an optional therapy for patients with early gastric cancer, whether patients with locally advanced gastric cancer (AGC) could benefit from laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy remains elusive due to a lack of comprehensive clinical data. To evaluate the efficacy of LADG, we conducted a multi-institutional randomized controlled trial to compare laparoscopy-assisted versus open distal gastrectomy (ODG) for AGC in North China.MethodsIn this RCT, after patients were enrolled according to the eligibility criteria, they were preoperatively assigned to LADG or ODG arm randomly with a 1:1 allocation ratio. The primary endpoint was the morbidity and mortality within 30 postoperative days to evaluate the surgical safety of LADG. The secondary endpoint was 3-year disease-free survival. This trial was registered at ClinicalTrial.gov as NCT02464215.ResultsBetween March 2014 and August 2017, a total of 446 patients with cT2-4aN0-3M0 (AJCC 7th staging system) were enrolled. Of these, 222 patients underwent LADG and 220 patients underwent ODG were included in the modified intention-to-treat analysis. The compliance rate of D2 lymph node dissection was identical between the LADG and ODG arms (99.5%, P = 1.000). No significant difference was observed regarding the overall postoperative complication rate in two groups (LADG 13.1%, ODG 17.7%, P = 0.174). No operation-related death occurred in both arms.ConclusionsThis trial confirmed that LADG performed by credentialed surgeons was safe and feasible for patients with AGC compared with conventional ODG.

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Section: Discussionmentioning

confidence: 48%

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

et al. 2018

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“…Diagnosis of PGS. PGS was diagnosed according to the following criteria, which were reported in our previous research [2]: ≥1 medical examinations confirming the absence of mechanical gastric outflow obstruction; stomach drainage volume > 800 mL/day sustained for >10 days; no obvious abnormality in fluid-electrolyte balance; no underlying disease, such as hypothyroidism or choroiditis, which may cause PGS; and no current treatment with any medications that may affect smooth muscle contraction.…”

Section: Methodsmentioning

confidence: 99%

“…Postsurgical gastroparesis syndrome (PGS) presents with symptoms suggesting gastric retention, including delayed gastric emptying, in the absence of mechanical obstruction [1]. Its prevalence following gastrectomy has been reported to be 0.4% to 5.0% [2]. PGS imposes significant social and economic burdens, including increased hospitalization time and healthcare costs [3].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Blood Glucose Level Predicts Postsurgical Gastroparesis Syndrome after Subtotal Gastrectomy: Development of an Individualized Usable Nomogram

Mao

Liu

Huang

et al. 2020

Journal of Diabetes Research

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Background. Postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy imposes significant social and economic burdens. We aimed to investigate the relationship between preoperative blood glucose level and PGS and develop a nomogram for individualized prediction. Patients and Methods. We retrospectively analyzed 633 patients with gastric cancer who underwent subtotal gastrectomy. Preoperative blood glucose levels were evaluated via receiver operating characteristic (ROC) curve analysis. Chi-squared tests and multivariable logistic regression analyses were used to develop a predictive model for PGS, presented as a nomogram, which was assessed for its clinical usefulness. Results. Thirty-eight of 633 patients were diagnosed with PGS. Based on the ROC curve analysis, the preoperative blood glucose cutoff value for PGS was 6.25 mmol/L. The predictors of PGS included preoperative hyperglycemia (odds ratio (OR) 2.3, P=0.03), body mass index (BMI; OR 0.21, P=0.14 for BMI<18.5 and OR 3.0, P=0.004 for BMI>24), and the anastomotic method (OR 7.3, P=0.001 for Billroth II and OR 5.9, P=0.15 for Roux-en-Y). The predictive model showed good discrimination ability, with a C-index of 0.710, and was clinically useful. Conclusions. Preoperative hyperglycemia effectively predicts PGS. We present a nomogram incorporating the preoperative blood glucose level, BMI, anastomotic method, and tumor size, for individualized prediction of PGS.

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“…Postsurgical Gp may also be seen after other surgeries, including esophagectomy (12%), distal gastrectomy with Roux-en-Y reconstruction (9%), lung transplantation (6%), paraesophageal hernia repair (4.4%) and fundoplication (3.8%) [78][79][80]. The presence of visceral obesity predicts the development of postsurgical Gp in patients undergoing distal gastrectomy for gastric cancer [81]. Postsurgical delay in gastric emptying may result in a higher severity of gastrointestinal symptoms.…”

Section: Role Of Gastric Emptying In Symptoms Of Gastroparesismentioning

confidence: 99%

Role of Gastric Emptying in Symptoms of Gastroparesis

Jehangir

Parkman

2019

Gastrointestinal Disorders

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The symptoms of gastroparesis, such as nausea, vomiting, postprandial fullness, early satiety and abdominal pain, frequently impair the quality of life of the affected individuals. The diagnosis of gastroparesis is made after structural etiologies are ruled out and an assessment of gastric function shows delayed gastric emptying. The role of the delay in gastric emptying in the pathogenesis of symptoms of gastroparesis has been debated, with some studies suggesting an association between delayed gastric emptying and the upper gastrointestinal symptoms, while others do not. The recent literature supports the importance of using reliable methods to assess gastric emptying, as delay in gastric emptying measured on a reliable test (4-h scintigraphy or breath test) is associated with the severity of upper gastrointestinal symptoms. In addition to measuring total gastric emptying, evaluation of regional gastric retention in the proximal and distal stomach and whole gut transit to assess small intestinal and colonic transit may provide additional useful information in patients with more generalized symptoms of gastrointestinal dysmotility.

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A quantified risk‐scoring system and rating model for postsurgical gastroparesis syndrome in gastric cancer patients

Abstract: Visceral obesity defined by VFA effectively predicted PGS. Our scoring system may be a reliable instrument for identifying patients most at risk of PGS.

Cited by 15 publications

References 29 publications

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

Preoperative Blood Glucose Level Predicts Postsurgical Gastroparesis Syndrome after Subtotal Gastrectomy: Development of an Individualized Usable Nomogram

Role of Gastric Emptying in Symptoms of Gastroparesis

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