Extent of Lymphadenectomy and Development of Delayed Gastric Emptying After Gastric Cancer Resection

Delayed gastric emptying (DGE) has been related to quality of life and clinical outcomes for gastric cancer patients. The role of lymphadenectomy in postoperative mechanics of gastric emptying remains undefined. This study aims to evaluate the association of D1 versus D2 lymphadenectomy with development of postgastrectomy DGE.

This institutional retrospective study is comprised of clinicopathologic data from patients who underwent gastrectomy between 1994 and 2023. Development of DGE was compared between patients who underwent D1 versus D2 lymphadenectomy in univariate and multivariate analyses, adjusting for other patient-specific and operative characteristics.

Of the 302 gastrectomy patients reviewed, 114 underwent distal or subtotal gastrectomy for gastric adenocarcinoma. Thirty of these patients (26.3%) developed DGE. Incidence of DGE was higher among patients who received a D2 (32%) versus D1 lymphadenectomy (15.4%). Adjusted for other covariates, D2 lymphadenectomy was independently associated with an increased likelihood of developing DGE (adjusted odds ratio 3.63, 95% confidence interval 1.12-11.8, P = 0.032). Additional risk factors for DGE identified in multivariate analysis included older age and postoperative complications. While patients with DGE experienced longer postoperative hospitalizations and more frequent 30-d readmissions, there was no difference in 30-d mortality, reoperation, overall survival, or progression-free survival.

In this retrospective study, D2 lymphadenectomy was identified as a risk factor for the development of postgastrectomy DGE in gastric cancer patients. However, long-term outcomes such as survival and cancer progression did not differ based on the development of DGE.