Abstract
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.
Highlights
Postsurgical gastroparesis syndrome (PGS) presents with symptoms suggesting gastric retention, including delayed gastric emptying, in the absence of mechanical obstruction [1]
Diabetes, which manifests as a group of metabolic diseases characterized by hyperglycemia, has been found to be associated with gastroparesis
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
Summary
Postsurgical gastroparesis syndrome (PGS) presents with symptoms suggesting gastric retention, including delayed gastric emptying, in the absence of mechanical obstruction [1]. Acute hyperglycemia significantly slows gastric emptying in both healthy individuals and those with type 1. 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. 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). 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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