Analysis of risk factors and prevention strategies for functional delayed gastric emptying in 1243 patients with distal gastric cancer

Abstract

Background Analysis of the risk factors associated with functional delayed gastric emptying after distal gastric cancer surgery to provide a basis for further reduction of the incidence of this complication. Methods Total of 1382 patients with distal gastric cancer from January 2016 to October 2018 were enrolled. Correlation analysis was performed in 53 patients with FDGE by logistic regression. Subgroup risk analysis was performed in 114 patients with preoperative pyloric obstruction. A Pearson Chi-square analysis was used to compare categorical variables between normal distribution groups. Meanwhile, a t test was used to compare continuous variables between groups. Odds ratio (OR) was used for comparison of the two groups, and it was summarized with its 95% confidence interval (CI) and p value using logistic regression. Result In multivariable analysis, age (OR 1.081, 95% CI, 1.047–1.117), BMI (OR 1.233, 95% CI, 1.116–1.363), preoperative pyloric obstruction (OR 3.831, 95% CI, 1.829–8.023), smaller volume of residual stomach (OR 1.838, 95% CI, 1.325–6.080), and anastomosis in greater curvature perpendicular (OR 3.385, 95% CI, 1.632–7.019) and in greater curvature parallel (OR 2.375, 95% CI, 0.963–5.861) were independent risk factors of FDGE. In the preoperative pyloric obstruction group, higher BMI (OR 1.309, 95% CI, 1.086–1.579) and preoperative obstruction time (OR 1.054, 95% CI, 1.003–1.108) were independent risk factors of FDGE and preoperative gastrointestinal decompression (OR 0.231, 95% CI, 0.068–0.785) was independent protective factor of FDGE. Conclusion Adequate gastrointestinal decompression should be performed before the operation to reduce the incidence of postoperative gastroparesis in patients with preoperative pyloric obstruction. We also could improve the surgical methods to reduce the occurrence of FDGE, such as controlling the size of the residual stomach, ensuring blood supply. Especially selecting an appropriate stapler and anastomosis during the anastomosis process, the occurrence of FDGE can be reduced.

Application of Overlap Gastroduodenostomy in Billroth I Anastomosis after Totally Laparoscopic Distal Gastrectomy for Gastric Cancer

“…All patients underwent D2 lymph node dissection, which may have influenced the blood supply to the remnant stomach, especially with a larger remnant stomach. is lack of blood supply might have caused delayed gastric emptying [21].…”

Risk factors associating with delayed gastric emptying after laparoscopic distal gastrectomy

“…However, their study did not identify the cutoff values for age. 7 Ellis et al reported that aging was a risk factor of DGE after pancreaticoduodenectomy. 11 They examined 10 502 patients who underwent pancreaticoduodenectomy for pancreatic cancer.…”

“…DGE has different definitions in the literature. 4,7,12 Cohen and Ottinger revealed that DGE is a condition in which patients cannot tolerate a solid diet after 2 weeks postoperatively. 12 Bar-Natan et al defined DGE as the inability to eat a regular diet after 10 days postoperatively.…”

“…12 Bar-Natan et al defined DGE as the inability to eat a regular diet after 10 days postoperatively. 4 Pang et al 7 diagnosed patients with DGE according to strict criterion items. That is, the drainage volume from the stomach tube should be <800 ml/day for >10 days.…”

“…Despite the controversies associated with DGE, the number of studies about this complication after distal gastrectomy for GC are limited. 6,7 The current study aimed to investigate the incidence of DGE and its clinical features and risk factors among those undergoing LDG.…”