Analysis Of High-risk Factors For Delayed Gastric Emptying After Colon Cancer

Purpose: The purpose of this study was to investigate the high-risk factors associate with delayed gastric emptying(DGE)after radical resection of colon cancer,and to build a nomogram model and clinical decision curve for this complication.Methods: This study retrospectively analyzed 1160 consecutive patients who underwent radical right hemicolectomy,enlarged right hemicolectomy,transverse colectomy,left hemicolectomy,enlarged left hemicolectomy in the Department of Colorectal Surgery,Union Medical Hospital,Fujian Medical University from January2012 to June 2018.The clinical pathological factors including gender,age,anesthesia risk score,body mass index,hypertension,diabetes,previous upper abdominal surgery,preoperative laboratory test result(albumin,hemoglobin,lymphocyte count),surgical access,surgical method,surgical duration,estimated blood loss and postoperative pathological stage.All meaningful factors by univariate analysis were entered into a logistic regression analysis to determine the independent risk factors for DGE,and to build a DGE nomogram model and clinical decision curve.Result: Among 1160 patients,20 were diagnosed as DGE,the incidence was 1.7%.The patients of Grade A,B and C were 10,6 and 4,respectively.The average postoperative gastric tube insertion time was 4.40 days,13.67 days,and 21.75 days,respectively.In the univariate analysis,age > 75 years old(5.6% vs 1.1%,P = 0.000),preoperative hemoglobin < 90g/L(4.9% vs 1.0%,P = 0.000),surgical duration >210min(3.3% vs.0.6%,P = 0.001),estimated blood loss > 90ml(3.0% vs.1.1%,P =0.019)and gastrocolic ligament lymph node dissection(3.6% vs.0.8%,P = 0.001)is associated with DGE.In multivariate analysis,age(OR=5.412,95%CI: 2.026-14.387,P=0.001),gastrocolic ligament lymph node dissection(OR=5.382,95% CI:1.937-14.387,P=0.001),and surgical duration(OR= 4.031,95% CI: 1.287-12.622,P=0.017)and preoperative hemoglobin level(OR=3.199,95% CI: 1.247-8.202,P=0.016)were independent risk factors for DGE.Conclusion: In this study,the incidence of DGE was 1.7% in patients undergoing radical surgery for colon cancer.Compared with patients without gastrocolic ligament lymph node dissection,there was a statistically significant difference in the incidence of DGE after Gastrocolic ligament lymph node dissection(3.6% vs.0.8%,P = 0.001).In multivariate analysis,age > 75 years old,preoperative hemoglobin < 90g/L,surgical duration > 210 min,and gastrocolic ligament lymph node dissection were independent risk factors for DGE.Based on the results of multivariate analysis,a DGE nomogram model after radical resection of colon cancer was established.A clinical decision curve was drawn to help doctors to formulate preoperative surgical plans and postoperative treatment strategies to reduce the occurrence of DGE after surgery.