title: Factors influencing clinically significant delayed gastric emptying after subtotal stomach-preserving pancreatoduodenectomy.
abstract: BACKGROUND
  Subtotal stomach-preserving pancreatoduodenectomy (SSPPD), in which the pylorus ring is resected and most of the stomach is preserved, has been performed recently in Japan. This study was undertaken to clarify the incidence of delayed gastric emptying (DGE) after SSPPD at a high-volume hospital and to determine the independent factors that influence the development of DGE after SSPPD.
  
  
  METHODS
  Between 2002 and 2011, 201 consecutive patients underwent standardized SSPPD. After SSPPD, DGE (defined according to the International Study Group of Pancreatic Surgery) was analyzed, and associated variables were assessed by univariate and multivariate analyses, retrospectively.
  
  
  RESULTS
  Clinically significant DGE (grades B and C) occurred in 35 (17 %) of the 201 patients; 26 patients had other accompanying abdominal complications (secondary DGE), and pancreatic leakage was the sole risk factor for DGE (odds ratio 6.63, 95 % CI 2.86-15.74; p < 0.001). Only nine (4 % of all patients) of the 35 patients with clinically significant DGE were classified as having DGE that had arisen without any obvious etiology (primary DGE).
  
  
  CONCLUSIONS
  DGE after SSPPD is strongly linked to the occurrence of other postoperative intra-abdominal complications such as pancreatic fistula. The incidence rate of primary DGE after SSPPD was 4 %. Although the ISGPS classification of DGE is clearly applicable, the grades do not explain why DGE occurs. Primary and secondary DGE should therefore be defined separately.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Sato
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishizaki
authors.forename: Jiro
authors.initials: J
authors.lastname: Yoshimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000368:Aged; D005260:Female; D018589:Gastroparesis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D061847:Hospitals, High-Volume; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors