Abstract
BackgroundAnalysis 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.MethodsTotal 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.ResultIn 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.ConclusionAdequate 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.
Highlights
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
Adequate surgical resection is the only curative therapeutic option for most Gastric cancer (GC) [2], while endoscopic procedures are recommended in low probability lymph node metastasis cases, and when lesion size and site are suitable for whole resection [3]
Patients We reviewed the records of patients with pathologically diagnosed gastric cancer, in which 1382 patients were treated with radical distal gastrectomy at the Department of General Surgery, Shanghai Changhai Hospital between 1st January 2016 and 1st January 2019
Summary
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. FDGE, which is a common complication after distal gastrectomy, has an incidence of 10% to 15% of which 5% to 10% with clinical symptoms. This complication causes patients to suffer from eating and leads to the reduction of the patients’ quality of life, and the increase of hospital stays and medical expenses, and the increase the workload and psychological pressure on doctors [5, 6]. Several studies have focused on FDGE, the reason remains unclear
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