N. Galouzis1, E.V. Alexander1, M. Fotinos1, O. Mitchel1, F. Bethel1, L. Mesropyan1, M.R. Khreiss1, T.S. Riall1, C. Luu1 1University Of Arizona, Division Of Surgical Oncology, Tucson, AZ, USA
Introduction: Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy that leads to significant morbidity and resource utilization. Classically, biochemical leaks after pancreatectomy are considered benign. The aim of this study was to analyze if grade A postoperative pancreatic fistula (POPF) impact rates of DGE.
Methods: Single-institution, retrospective study (2020-2023) of patients undergoing pancreatectomy. Incidence of POPF and DGE were evaluated and classified by no DGE, primary DGE, and secondary DGE (secondary to another intraabdominal complication). Pre-, intra-, and post-operative factors were recorded to evaluate risk factors associated with DGE.
Results: Of 170 patients, 51 patients (30%) developed DGE, the majority of which was primary DGE (64.7%). The average age was 67.2±11.4 years and there was no significant difference in demographics between groups. Overall, classic pancreaticoduodenectomy (92.4%) was the most common operation. Intraoperatively, patients with primary DGE were more likely to have a handsewn gastrojejunostomy (78.8% vs. 58.0% vs. 44.4%, p=0.05) compared to no DGE and secondary DGE respectively. Postoperatively, 39.4% (n=13) of patients with primary DGE had a grade A POPF and no other intraabdominal complications. On regression analysis, after adjusting for age and BMI, handsewn gastrojejunostomy (8.99, 95%CI 1.56, 51.75, p=0.01) and grade A POPF (3.45, 95%CI 1.01, 11.82, p=0.05) continued to have higher odds of primary DGE. Additionally, secondary DGE, compared to no DGE and primary DGE, was more likely to have a longer length of stay (20.9±13.5 vs. 7.2±2.5 vs 11.4±6.1, p<0.01), to be discharged to a skilled nursing facility (22.2% vs. 3.4% vs. 3.0%, p=0.01). Patients with no DGE had the lowest rate of 30-day readmission, however, primary and secondary DGE were similar (11.8% vs. 39.4% vs. 44.4%, p<0.01).
Conclusion: Primary DGE occurs in roughly 1 in 5 patients. Handsewn gastrojejunostomy reconstruction and grade A pancreatic leak increase the odds of primary DGE. This association challenges the benign nature of these biochemical leaks.