Comprehensive Analysis Of Risk Factors Affecting Delayed Gastric Emptying Following Pancreaticoduodenectomy

Background: Pancreaticoduodenectomy(PD)is the largest operation in general surgery except for organ transplantation.It is very difficult operation with a large surgical scope and many organs involved.As the first choice for the treatment of periampullary tumors,it has been developed for decades.With the development of science and technology and the accumulation of surgical experience,the perioperative mortality of PD has been significantly decreased,but the incidence of PD postoperative complications is still high.Delayed Gastric Emptying(DGE)after PD does not endanger the patient’s life,however,it can significantly increase the length of hospital stay and seriously affect the patient’s quality of life.With the rise of the concept of ERAS,more and more medical centers begin to pay attention to the prevention and treatment of DGE after PD.As for the definition and diagnosis of DGE after PD,there has been a lot of controversy since the international study group of pancreatic surgery(ISGPS)put forward its recommended diagnostic and grading standards in 2007.Some research have shown that it does not meet the DGE’s diagnosis and treatment needs of the Asian patients,while the diagnostic and grading standards proposed by Japanese scholar Tani et al are more in line with the Chinese patients.This study retrospectively analyzed the medical records of PD patients,compared the accuracy of ISGPS2007 and Tani2006 in the diagnosis of DGE after PD,and further studied the risk factors of DGE after PD on this basis,so as to provide theoretical support and help for the perioperative clinical decision making of prevention and treatment of DGE for PD patients.Methods: The clinical data of patients undergoing pancreaticoduodenectomy in general surgery,hepatobiliary surgery and gastrointestinal surgery in the second affiliated hospital of Dalian medical university from January 2008 to October 2018 were retrospectively analyzed.Descriptive analysis was performed on postoperative gastric tube retention,postoperative feeding time with tube,and postoperative ventilator assisted breathing,to further compare the authenticity of ISGPS2007 and Tani2006 in the diagnosis of DGE after PD.Then the independent risk factors affecting the occurrence of DGE after PD were obtained by univariate analysis and Logistic regression analysis.Results: 1.Days of NGT(DNGT)after PD was 2.36 days longer than days of NGT>500ml(DNGT500);2.In the patients diagnosed by ISGPS2007 with postoperative PD DGE and DNGT500 = 4-7d,the average postoperative tracheal intubation was 1.67 days.Average feeding days with tube was 1.31 days;In the patients diagnosed by ISGPS2007 with postoperative PD DGE and DNGT500 = 8-10 d,the average postoperative tracheal intubation was 2.00 days.Average feeding days with tube was 1.22 days;3.In ISGPS2007,postoperative DNGT was used as the main dimension to diagnose DGE after PD,but the use of postoperative ventilator and feeding with tube would seriously affect the accuracy of DGE after PD diagnosis by ISGPS2007,Tani2006 is more in line with the patient population in this study and can more accurately diagnose DGE after PD surgery;4.Based on the Tani2006 diagnostic criteria,preoperative serum bilirubin level,operative duration,intraoperative blood loss,number of intraoperative lymph nodes dissected,and tumor location were independent risk factors for DGE after PD;5.The patients in this study were divided into four groups according to the chronological sequence,and the incidence of DGE was 41.67%,39.37%,29.73%,and 21.05% respectively.Conclusion: The duration of NGT detention after PD surgery was interfered by multiple factors.In this study,only three factors were listed,"NGT observation period,feeding time with tube,and postoperative breathing time assisted by tracheal intubation and ventilator",which should be carefully treated when using NGT duration as evaluation index to diagnose DGE after PD surgery.Tani2006 is more suitable for DGE study after PD surgery in this research center.According to the actual situation of each medical center,which standard or better solution should be adopted.In this study,it was found that higher serum total bilirubin level before surgery,longer operative time,more intraoperative blood loss,more intraoperative lymph node dissection,and pyloruspreserving pancreaticoduodenectomy were independent risk factors for DGE after PD.