# Risk Factors for Long-Term Delayed Gastric Emptying and Its Impact on the Quality of Life After Laparoscopic Pylorus-Preserving Gastrectomy in Patients with Gastric Cancer: Secondary Analysis of the Prospective Multicenter Trial KLASS-04

## TL;DR

This study found that patients without prior abdominal surgery are at higher risk for long-term delayed gastric emptying after a specific type of stomach cancer surgery, which negatively affects their quality of life.

## Contribution

The study identifies previous abdominal surgery as a novel protective factor against long-term delayed gastric emptying after pylorus-preserving gastrectomy.

## Key findings

- Patients without previous abdominal surgery had a 32% incidence of DGE compared to 4.8% in those with prior surgery.
- DGE was associated with more symptoms like nausea, vomiting, constipation, and dry mouth.
- DGE significantly reduced the quality of life for patients despite avoiding known risk factors.

## Abstract

Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial showed an unneglectable incidence—21/124 patients (16.3%)—of long-term DGE compared to those who underwent laparoscopic distal gastrectomy. This study aimed to identify the multifactorial risk factors associated with DGE and analyze the quality of life (QoL) of patients with DGE following LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients.

Background/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients.