Postoperative Delayed Emptying after Total, Subtotal, or Distal Gastrectomy for Gastric Cancer - a Population-based Study

Background To examine the rate of delayed emptying and other 90-day postoperative complications after total, subtotal, and distal gastrectomy for gastric adenocarcinoma in a population-based setting. Methods This study included all patients undergoing total, subtotal, or distal gastrectomy for gastric cancer in Finland in 2005-2016, with follow-up until December 31, 2019. Logistic regression provided odds ratios with 95% confidence intervals of 90-day mortality. Results were adjusted for age, sex, year of surgery, comorbidities, pathological stage, surgical approach, and neoadjuvant therapy. Results A total of 2,058 patients underwent total (n=1,227), subtotal (n=450), or distal (n=381) gastrectomy. The rate of delayed emptying was 1.7% vs. 1.3% vs. 2.1% in the whole cohort and 1.6% vs. 1.8% vs. 3.5% in the subgroup analysis of R0 resections, respectively. Resection type was not associated to the risk of delayed emptying. Subtotal gastrectomy was associated with lower risk of major complications and re-operations and distal gastrectomy was associated with lower risk of anastomotic leak. Conclusions The extent of resection did not affect delayed emptying while less postoperative complications were seen after subtotal or distal gastrectomy compared to total gastrectomy.