遠位胃切除術後の術後胃不全麻痺症候群および生存転帰の予測ノモグラム：詳細な分析

Postsurgical gastroparesis syndrome (PGS) is a common complication after distal gastrectomy that impairs quality of life and increases healthcare costs, yet its risk factors and long-term prognostic impact remain unclear.

To identify PGS risk factors after radical distal gastrectomy, develop and validate a model, and assess its association with long-term survival.

We retrospectively analyzed patients undergoing radical distal gastrectomy at Qilu Hospital of Shandong University between January 2012 and December 2023. Patients were assigned to training and validation cohorts by surgery date. Logistic regression was used to identify independent risk factors and develop a PGS prediction nomogram. Propensity score overlap weighting (PSOW) was applied to reduce confounding, and the prognostic impact of PGS was assessed using weighted Kaplan-Meier analysis, log-rank tests, and Cox regression.

A total of 2490 patients were included (training cohort: 1934 [77.7%]; validation cohort: 556 [22.3%]), among whom 238 developed PGS (training cohort: 187). Independent risk factors included prolonged operative time (OR = 1.01), intellectual work (OR = 2.02), well-controlled diabetes (OR = 3.10), poorly controlled diabetes (OR = 4.95), history of constipation (OR = 2.46), preoperative pyloric obstruction (OR = 3.77), perioperative psychiatric symptoms (OR = 4.60), and Billroth II (OR = 3.07) or Roux-en-Y anastomosis (OR = 6.29). Protective factors were higher preoperative plasma albumin (OR = 0.96) and laparoscopic surgery (OR = 0.47) (all p < 0.05). The nomogram showed good discrimination and calibration, with AUCs of 0.81 for the training cohort, 0.81 for internal validation, and 0.82 for temporal validation. Patients with PGS exhibited significantly worse survival outcomes, and PGS was independently associated with poorer survival in the overlap-weighted analysis (HR 1.41, 95% CI 1.12-1.79, p = 0.004).

The nomogram prediction model based on the risk factors for PGS occurrence has potential value in predicting the onset of PGS. PGS is significantly associated with the prognosis of patients after radical surgery for distal gastric cancer.

This study was registered at the Chinese Clinical Trial Registry (Registration No.: ChiCTR2300069234).