[Analysis of risk factors and predictive model construction for Roux-en-Y stasis syndrome after distal gastrectomy...

Objective: To analyze the risk factors and construct a predictive model for Roux-en-Y stasis syndrome (RSS) after distal gastrectomy for gastric cancer. Methods: A retrospective analysis was conducted on the clinical data of 351 patients who underwent distal gastrectomy for gastric cancer at Suzhou Ninth People Hospital, Affiliated to Soochow University, from January 2012 to December 2023, including 194 males and 157 females, with the age of (60.8±7.9) years. According to the occurrence of RSS, patients were divided into the RSS group (n=36) and the non-RSS group (n=315). Multivariate logistic regression analysis was used to identify risk factors for RSS, and a nomogram prediction model was constructed. The predictive ability, accuracy, and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Results: Patients in the RSS group had higher age, body mass index, proportion with a history of smoking, proportion with diabetes, proportion receiving neoadjuvant chemotherapy, and proportion with delayed postoperative ambulation (>48 h) compared to those in the non-RSS group (all P<0.05). In contrast, patients in the RSS group exhibited lower albumin levels, proportion of tumors located in the gastric body, proportion undergoing laparoscopic surgery, proportion of linear stapler usage, and proportion undergoing duodenal fixation compared to the non-RSS group (all P<0.05). Multivariate logistic regression analysis showed that increased age (OR=1.080, 95%CI: 1.011-1.155), elevated body mass index (OR=1.227, 95%CI: 1.033-1.457), and delayed postoperative ambulation time (>48-72 h: OR=3.042, 95%CI: 1.058-8.747;>72 h: OR=4.152, 95%CI: 1.341-12.852) were risk factors for RSS. In contrast, increased albumin levels (OR=0.821, 95%CI: 0.687-0.981), tumors located in the gastric body (OR=0.237, 95%CI: 0.072-0.788), laparoscopic surgery (OR=0.293, 95%CI: 0.106-0.808), the use of linear staplers (OR=0.224, 95%CI: 0.090-0.557), and duodenal fixation (OR=0.154, 95%CI: 0.033-0.726) were protective factors for RSS. A nomogram prediction model for RSS after distal gastrectomy was constructed based on these parameters. The model achieved an AUC of 0.883 (95%CI: 0.840-0.927), with a sensitivity of 97.2% and specificity of 70.5%. The calibration curve showed good agreement between predicted and observed values, and the Hosmer-Lemeshow goodness-of-fit test indicated good model fit (P=0.425). DCA demonstrated satisfactory clinical net benefit for the model. Conclusions: Advanced age, elevated body mass index, and delayed postoperative ambulation (>48 h) are risk factors for RSS. Higher albumin level, tumor located in the gastric body, laparoscopic surgery, use of linear stapler, and duodenal stump fixation are protective factors for RSS. The nomogram of the predictive model that incorporates the aforementioned factors demonstrates good predictive capability.