Abstract
Background
Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy
associated with a low complication burden but a prolonged hospital stay. The present
study aimed to characterize DGE, with a particular focus on its subtypes and related
predictors.
Methods
A 2-center retrospective analysis was performed including consecutive pancreatoduodenectomy
over 5 years. Primary delayed gastric emptying (pDGE) and secondary delayed gastric
emptying (sDGE) were defined according to the presence of concomitant causing factors.
Predictors of DGE, pDGE and sDGE were assessed through logistic regression.
Results
Out of 1,170 patients considered, 188 developed delayed gastric emptying (16.1%).
Most DGE (71.8%) were secondary. sDGE resolved later (P = .007), with hospital stay, duration of total parenteral nutrition, and of enteral
nutrition being longer than for pDGE (all P < .005). Smoking status, total operative time, indication for surgery other than
pancreatic cancer, estimated blood loss, and soft pancreatic texture were independent
predictors of DGE. In the subgroup analysis of pDGE, smoking was the only independent
predictor, whereas pylorus-preservation was a protective factor. Smoking, indication
for surgery, estimated blood loss, soft gland texture, and main pancreatic duct diameter
were independent predictors of sDGE.
Conclusion
DGE after pancreatoduodenectomy consists of 2 different subtypes. The primary form
resolves earlier, and its occurrence might be reduced by pylorus preservation. For
the secondary form, clinicians should focus on preventing and treating other trigger
complications. The diagnosis of the DGE subtype has critical therapeutic implications
and paves the way for further systematic studies.
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Article info
Publication history
Published online: January 24, 2023
Accepted:
December 13,
2022
Publication stage
In Press Corrected ProofFootnotes
Giovanni Marchegiani and Anthony Di Gioia share first authorship; Roberto Salvia and Luca Gianotti share last authorship.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
