Background/Objectives:Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG.Methods:DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups.Results:DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%,p= 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824,p= 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p= 0.004), constipation (p= 0.04), and a dry mouth (p= 0.005).Conclusions:Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients.
背景/目的：胃排空延迟是腹腔镜保留幽门胃切除术的已知并发症。在KLASS-04试验（一项比较LPPG与腹腔镜远端胃切除术的前瞻性多中心随机对照研究）中，接受LPPG治疗的患者与接受LDG治疗的患者相比，长期DGE的发生率不容忽视。本研究旨在识别与DGE相关的多因素风险因素，并分析LPPG术后发生DGE患者的生活质量。 方法：DGE定义为术后1年、2年和3年内镜随访中至少出现一次"近乎正常的饮食残留"。研究比较了DGE组与非DGE组的临床病理特征、手术结果及生活质量。 结果：在接受LPPG的124例患者中，21例（16.3%）出现DGE。单因素分析显示，无腹部手术史的患者DGE发生率更高（32% vs. 4.8%，p=0.011），逻辑回归分析进一步证实这一关联（比值比：0.106，95%置信区间：0.014-0.824，p=0.032）。DGE患者更常报告恶心呕吐（p=0.004）、便秘（p=0.04）和口干（p=0.005）等症状。 结论：尽管KLASS-04试验中LPPG组采用了严格方案以避免已知的DGE风险因素（如迷走神经肝支损伤、幽门下动静脉损伤及胃窦残端过短），但仍出现相当比例的DGE发生率。除无既往手术史外，未发现其他临床病理或手术因素可作为DGE的多因素风险因素。然而，DGE确实对患者生活质量产生了负面影响。
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