Gastroparesis following anatomical resection for lung cancer: clinical characteristics and implications

Gastroparesis is a rare complication of thoracic surgery, defined as delayed gastric emptying without mechanical obstruction. Gastroparesis may worsen outcomes; however, data after lung resection are scarce. We aimed to determine the incidence, perioperative factors, and course of postoperative gastroparesis after anatomical lung resection for lung cancer.

We retrospectively reviewed records of 1623 adult patients who underwent anatomical lung resection (2018-2022). Gastroparesis was defined as postoperative upper gastrointestinal symptoms with radiographic gastric dilatation without mechanical obstruction. Univariate comparisons were performed using the Wilcoxon rank-sum or Fisher's exact tests. Because of the infrequency of events, an exploratory multivariate analysis was conducted using Firth-penalized logistic regression with pre-specified covariates (clinical stage, lesion laterality, and extent of lymph node dissection).

Eight patients developed postoperative gastroparesis (0.49%, 8/1623). Affected patients tended to have left-sided and clinically advanced disease, and a longer operative time (median 210 vs. 147 min), greater blood loss (median 90 vs. 10 mL), and longer hospital stay (median 26 vs. 8 days). Onset occurred on postoperative days 2-6. All patients recovered with conservative management, without surgery. In Firth regression, left-sided resection and advanced stage increased odds of gastroparesis (adjusted odds ratio 3.67, 95% confidence interval 0.93-20.04; p = 0.064 and 3.17, 0.78-16.17; p = 0.108), respectively, whereas extent of lymph node dissection was not associated (1.44, 0.24-15.16; p = 0.706).

Postoperative gastroparesis, although rare, was associated with prolonged hospitalization. Early recognition and supportive management are warranted, particularly after complex procedures.