The Effects of Delayed Gastric Emptying After Pancreaticoduodenectomy on Oncological Prognosis

Abstract

Introduction: Delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) is known to cause prolonged hospitalization, decrease patient quality of life (QOL) and poor nutrition. However, the effects of DGE after PD on oncological prognosis is unknown. Objective in this study is to examine the effect of DGE after PD on the oncological prognosis. Methods: The subjects consisted of 436 patients who underwent PD at the 4 affiliate hospitals from 2003 to 2010. DGE and pancreatic fistula were defined in accordance with ISGPS classification. The patients were classified into those without DGE (Group A, n=269) and those with DGE (Group B, n=167). The effect of DGE on prognosis was investigated by analyzing background factors and preoperative, intraoperative as well as postoperative factors. Results: The overall incidence of DGE after PD was 38.3% (167/436 cases), with the distribution of the degree of DGE of Group B in the order of grade A, B, and C as follows: 58 (34.8%), 53 (31.7%), and 56 (33.5 %). Significantly different background factors (P < 0.05) between the two groups consisted of intraoperative blood loss (905 vs. 1,098 ml), postoperative day of pancreaticojejunal drain removal (7 vs. 9 days), duration of postoperative hospital stay (31 vs. 37 days), and the extent of gastrectomy (PD, SSPPD, or PPPD). With regard to prognosis, the three- and 5-year OS rate of Group A were 51.3% and 34.9%, respectively, as compared to were 35.7% and 26.1%, respectively in Group B, with a significant difference between the two groups (P=0.001). Analysis of gender, age, primary disease and stage, operation time, intraoperative blood loss, DGE (grade A, B, or C), and pancreatic fistula (grade A, B, or C) as confounding factors using Cox proportional hazards model found that primary disease [hazard ratio: pancreatic cancer 2.99 (P=0.001) and cholangiocarcinoma 2.25 (P=0.001) as compared to papilla Vater cancer], staging [hazard ratios of stage II, III, IV were 4.12, 6.37, 13.2, respectively (P < 0.003) as compared to stage I], and DGE (grade C) [hazard ratio 2.38 (P=0.017) ] have been identified as significant poor prognostic factors. Conclusion: DGE particularly grade C leads not only to prolonged hospitalization and deterioration of QOL, but also is associated with worse oncological prognosis.Figure 1