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Risk factors for delayed gastric emptying after esophagectomy

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Abstract

Purpose

Delayed gastric emptying (DGE) is a common functional disorder after esophagectomy with gastric tube reconstruction. Little is known about risk factors that can predict this debilitating complication.

Methods

Patients who underwent elective esophagectomy from 2008 to 2016 in a single center were retrospectively reviewed. Diagnosis of DGE was based on clinical, radiological, and endoscopic findings. Uni- and multivariate analyses were performed to identify patient-, tumor-, and procedure-related factors that increase the risk of DGE.

Results

One hundred eighty-two patients were included. Incidence of DGE was 39.0%. Overall, 27 (14.8%) needed an endoscopic intervention. Patients in the DGE group had a longer hospital stay (p < 0.01). No differences were found for the 30-day (p = 1.0) and hospital mortality (p = 1.0). On univariate analyses, a significant influence on DGE was demonstrated for pre-existing pulmonary comorbidity (p = 0.04), an anastomotic leak (p < 0.01), and postoperative pulmonary complications (pneumonia: p = 0.02, pleural empyema: p < 0.01, and adult respiratory distress syndrome: p = 0.03). Furthermore, there was a non-significant trend toward an increased risk for DGE for the following variable: female gender (p = 0.09) and longer operative time (p = 0.09). On multivariate analysis, only female gender (p = 0.03) and anastomotic leak (p = 0.01) were significantly associated with an increased risk for DGE.

Conclusions

DGE is a frequent complication following esophagectomy that can successfully be managed with conservative or endoscopic measures. DGE did not increase mortality but was associated with increased morbidity and prolonged hospitalization. We identified risk factors that increase the incidence of DGE. However, this has to be confirmed in future studies with standardized definition of DGE.

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Authors’ contributions

Study conception and design: Benedix F., Schubert D., and Stübs P.; acquisition of data: Benedix F. and Willems T.; analysis and interpretation of data: Kropf S., Benedix F., and Willems T.; drafting of manuscript: Wolff S. and Benedix F.; and critical revision of manuscript: Wolff S., Kropf S., Schubert D., and Stübs P.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Frank Benedix, Tobias Willems & Stephanie Wolff

  2. Institute for Biometry and Medical Informatics, University Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Siegfried Kropf

  3. Department of Surgery, Hospital Klinikum Saarbrücken gGmbH, Winterberg 1, 66119, Saarbrücken, Germany

    Daniel Schubert

  4. Department of Surgery, Hospital DRK Kliniken Berlin Köpenick, Salvador-Allende Strasse 2-8, 12559, Berlin, Germany

    Patrick Stübs

Authors
  1. Frank Benedix
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  2. Tobias Willems
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  3. Siegfried Kropf
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  4. Daniel Schubert
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  5. Patrick Stübs
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  6. Stephanie Wolff
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Correspondence to Frank Benedix.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.

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Benedix, F., Willems, T., Kropf, S. et al. Risk factors for delayed gastric emptying after esophagectomy. Langenbecks Arch Surg 402, 547–554 (2017). https://doi.org/10.1007/s00423-017-1576-7

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  • DOI: https://doi.org/10.1007/s00423-017-1576-7

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