Clinically relevant burden of delayed gastric emptying after left pancreatectomy and its predictors

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Few studies have examined delayed gastric emptying (DGE) following left pancreatectomy (LP). This study aimed to assess the incidence and impact and identify predictive pre/intra-operative predictors. We conducted a retrospective, single-centre cohort including all adult patients who underwent LP from 2017 to 2024. Variables were analyzed using univariate and multivariable analysis. Among 213 LP patients, 34 (16.0%) developed DGE (grade A 11.7%, B 3.3%, C 0.9%). DGE was associated with longer hospitalization [30.50 (20.75-46.50) vs 14.00 (11.00-20.00) days, P < 0.001], higher major complications (67.6% vs 29.6%, P < 0.001), and more ICU stays (29.4% vs 13.4%, P = 0.025); even isolated grade A DGE (no other complications) prolonged length of stay than in patients without any complications [20.00 (15.00-29.50) vs 12.00 (10.00-15.00) days, P = 0.021]. DGE was linked to clinically relevant POPF (52.9% vs 29.6%; P = 0.010) and intra-abdominal abscess with invasive therapy (20.6% vs 6.1%; P = 0.015). In multivariable analysis, portal (PV)/superior mesenteric vein (SMV) resection (OR 4.525, P = 0.017) and pancreatic ductal adenocarcinoma (PDAC) histology (OR 3.121, P = 0.024) were independent predictors of DGE. DGE is a frequent and under-estimated complication after LP, prolonging postoperative hospitalization; notably, even grade A DGE was linked to longer length of stay. PDAC histology and PV/SMV resection were independent risk factors for DGE. Identifying these predictors enables prediction of DGE and supports targeted prevention and perioperative management.

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