Incidence, risk factors, recovery duration, and prognostic implications of gastroparesis following radical distal gastrectomy for gastric cancer: a large retrospective cohort study

Background: Gastroparesis is a significant early complication following radical distal gastrectomy (RDG) for gastric cancer. However, the full spectrum of clinical characteristics, recovery duration, and prognostic implications of postoperative gastroparesis (PGS) has yet to be elucidated clearly. Methods: Patients who underwent RDG for gastric cancer were identified from the National Cancer Center (NCC) of China between 2010 and 2020. Propensity score matching (PSM) was used to adjust for selection biases. Logistic regression models or Cox proportional hazards models were employed to identify risk factors or prognostic factors, respectively. Results: Among the 4649 patients who underwent RDG, 104 cases (2.2%) developed PGS. Age ≥ 60 years [odds ratio (OR), 1.600 (1.075–2.380), P = 0.020], smoking history [OR, 2.793 (1.842–4.234), P < 0.001], long operative time [OR, 1.005 (1.001–1.008), P = 0.004], intraoperative blood transfusion [OR, 2.183 (1.371–3.477), P = 0.001], low tumor differentiation [OR, 3.019 (1.877–4.856), P < 0.001], and absence of neoadjuvant therapy [OR, 4.610 (1.443–14.724), P = 0.010] were identified as independent risk factors for PGS. The median recovery time for PGS was 19 (interquartile range (IQR): 13–30) days. Multivariate analysis revealed that a greater distance from cardia to anastomosis [OR, 1.795 (1.252–2.573), P = 0.001] and older age [OR, 1.058 (1.002–1.117), P = 0.042] were associated with prolonged recovery time of PGS. No significant differences in in-hospital mortality ( P = 0.479) and overall survival (OS) ( P = 0.503) were observed between the PGS and non-PGS groups. Furthermore, multivariate analysis indicated that patients with longer PGS recovery time had worse OS compared to patients with shorter PGS recovery time [hazard ratio (HR), 0.487 (0.245–0.967), P = 0.040] and non-PGS patients [HR, 0.506 (0.281–0.911), P = 0.023]. Conclusion: Age, smoking history, operative time, intraoperative blood transfusion, tumor differentiation, and neoadjuvant therapy were independent risk factors for PGS after RDG. Notably, a greater distance from cardia to anastomosis was significantly associated with prolonged recovery time of PGS. Furthermore, longer PGS recovery time independently predicted poorer OS, highlighting the significance of early intervention for PGS.