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

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.