SpringerLink
Log in

Gastrocolic ligament lymph-node dissection may increase the incidence of delayed gastric emptying after colon cancer surgery with D3 lymphadenectomy

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Delayed gastric emptying (DGE) is associated with prolonged hospital stay and higher healthcare costs. This study aimed to investigate the risk factors for DGE after D3 radical resection for colon cancer and to build a nomogram for this complication.

Methods

We analyzed, retrospectively, 1160 consecutive patients who underwent surgery with D3 lymphadenectomy for colon cancer between January, 2012 and June, 2018. A multivariate logistic regression analysis was used to identify the risk factors for DGE and to build a DGE nomogram model.

Results

There were ten, six and four patients with DGE classified as grades A, B and C, respectively, representing a DGE rate of 1.7%. Multivariate analysis revealed that age (P = 0.001), dissection of the gastrocolic ligament lymph nodes (GCLNs) (P = 0.001), surgical duration (P = 0.017) and preoperative hemoglobin level (P = 0.016) were independent risk factors, and were included to build a predictive model for DGE. The therapeutic index of GCLN dissection was approximately half that of D3 lymphadenectomy (2.9 vs. 5.6).

Conclusions

DGE is more likely to develop in patients aged > 75 years, those with a preoperative hemoglobin < 90 g/L, those with a surgical duration > 210 min, and those who undergo GCLN dissection. The nomogram may facilitate the stratification of patients at risk for DGE following D3 lymphadenectomy for colon cancer. Assessing long-term outcomes will help to evaluate the survival benefit of GCLN dissection in the future, to avoid unnecessary dissection and reduce the incidence of DGE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and materials

The data for this study were obtained retrospectively from a collected colorectal cancer database at the Colorectal Cancer Surgery department at our institution.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics 2020. CA Cancer J Clin. 2020;70(1):7–30.

    Article  Google Scholar 

  2. Parkin DM, Ferlay J, Curado MP, Bray F, Edwards B, Shin HR, et al. Fifty years of cancer incidence: CI5 I-IX. Int J Cancer. 2010;127(12):2918–27.

    Article  CAS  Google Scholar 

  3. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation: technical notes and outcome. Colorectal Dis. 2009;11(4):354–64.

    Article  CAS  Google Scholar 

  4. Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Jepsen LV, Kristensen B, et al. Lymph node metastases in the gastrocolic ligament in patients with colon cancer. Dis Colon Rectum. 2014;57(7):839–45.

    Article  Google Scholar 

  5. Uematsu D, Akiyama G, Sugihara T, Magishi A, Yamaguchi T, Sano T. Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure. Asian J Endoscop Surg. 2017;10(1):23–7.

    Article  Google Scholar 

  6. Feng B, Ling TL, Lu AG, Wang ML, Ma JJ, Li JW, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc. 2014;28(2):477–83.

    Article  Google Scholar 

  7. Hasegawa S, Kawamura J, Nagayama S, Nomura A, Kondo K, Sakai Y. Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers. Surg Endosc. 2007;21(9):1657.

    Article  Google Scholar 

  8. Miki Y, Tokunaga M, Bando E, Tanizawa Y, Kawamura T, Terashima M. Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification. J Gastrointest Surgery Off J Soc Surg Aliment Tract. 2011;15(11):1969–76.

    Article  Google Scholar 

  9. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.

    Article  Google Scholar 

  10. Fagard K, Casaer J, Wolthuis A, Flamaing J, Milisen K, Lobelle JP, et al. Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer. Colorectal Dis Off J Assoc Coloproctol Great Br Irel. 2017;19(9):O329–38.

    CAS  Google Scholar 

  11. Neoptolemos JP, Stocken DD, Dunn JA, Almond J, Beger HG, Bassi C, et al. Influence of resection margins on survival for patients with resectable pancreatic cancer treated with chemoradiation or chemotherapy within the European Study Group for Pancreatic Cancer 1 study. Br J Surg. 2002;89:377–377.

    Article  Google Scholar 

  12. Futagawa Y, Kanehira M, Furukawa K, Kitamura H, Yoshida S, Usuba T, et al. Impact of delayed gastric emptying after pancreaticoduodenectomy on survival. J Hepato-Biliary-Pancreat Sci. 2017;24(8):466–74.

    Article  Google Scholar 

  13. Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2015;19(9):1572–80.

    Article  Google Scholar 

  14. Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB Off J Int Hepato Pancreato Biliary Assoc. 2010;12(9):610–8.

    Article  Google Scholar 

  15. Park JS, Hwang HK, Kim JK, Cho SI, Yoon DS, Lee WJ, et al. Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification. Surgery. 2009;146(5):882–7.

    Article  Google Scholar 

  16. Sakamoto Y, Yamamoto Y, Hata S, Nara S, Esaki M, Sano T, et al. Analysis of risk factors for delayed gastric emptying (DGE) after 387 pancreaticoduodenectomies with usage of 70 stapled reconstructions. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(10):1789–97.

    Article  Google Scholar 

  17. Shinohara H, Kurahashi Y, Kanaya S, Haruta S, Ueno M, Udagawa H, et al. Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery. Gastric Cancer Off J Int Gastric Cancer Assoc Japanese Gastric Cancer Assoc. 2013;16(4):615–20.

    CAS  Google Scholar 

  18. Wang XJ, Chi P, Lin HM, Lu XR, Huang Y, Xu ZB, et al. Risk factors for early postoperative small bowel obstruction after elective colon cancer surgery: an observational study of 1244 consecutive patients. Digestive Surg. 2018;35(1):49–54.

    Article  Google Scholar 

  19. Lo CH, Chen JH, Wu CW, Lo SS, Hsieh MC, Lui WY. Risk factors and management of intra-abdominal infection after extended radical gastrectomy. Am J Surg. 2008;196(5):741–5.

    Article  Google Scholar 

  20. Sahara K, Watanabe J, Ishibe A, Goto K, Takei S, Suwa Y, et al. Optimal extent of central lymphadenectomy for right-sided colon cancers: is lymphadenectomy beyond the superior mesenteric vein meaningful? Surg Today. 2020. https://doi.org/10.1007/s00595-020-02084-6.

    Article  PubMed  Google Scholar 

  21. Sahara K, Tsilimigras DI, Merath K, Bagante F, Guglielmi A, Aldrighetti L, et al. Therapeutic index associated with lymphadenectomy among patients with intrahepatic cholangiocarcinoma: which patients benefit the most from nodal evaluation? Ann Surg Oncol. 2019;26(9):2959–68.

    Article  Google Scholar 

  22. Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Miyoshi M, Kajiwara Y, et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg. 2007;245(1):80–7.

    Article  Google Scholar 

  23. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82(3):346–51.

    Article  CAS  Google Scholar 

  24. Panwar R, Pal S. The international study group of pancreatic surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Panc Dis Int. 2017;016(004):353–63.

    Article  Google Scholar 

  25. Welsch T, Borm M, Degrate L, Hinz U, Buchler MW, Wente MN. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg. 2010;97(7):1043–50.

    Article  CAS  Google Scholar 

  26. Kunstman JW, Fonseca AL, Ciarleglio MM, Cong X, Hochberg A, Salem RR. Comprehensive analysis of variables affecting delayed gastric emptying following pancreaticoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16(7):1354–61.

    Article  Google Scholar 

  27. Code CF, Marlett JA. The interdigestive myo-electric complex of the stomach and small bowel of dogs. J Physiol. 1975;246(2):289–309.

    Article  CAS  Google Scholar 

  28. Lu YF, Zhao G, Guo CY, Jia SR, Hou YD. Vagus effect on pylorus-preserving gastrectomy. World J Gastroenterol. 1999;5(2):177–8.

    Article  Google Scholar 

  29. Kiyokawa T, Hiki N, Nunobe S, Honda M, Ohashi M, Sano T. Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy. Langenbeck’s Arch Surg. 2017;402(1):49–56.

    Article  Google Scholar 

  30. Suh YS, Han DS, Kong SH, Kwon S, Shin CI, Kim WH, et al. Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer. Ann Surg. 2014;259(3):485–93.

    Article  Google Scholar 

  31. Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer Off J Int Gastric Cancer Assoc Japanese Gastric Cancer Assoc. 2007;10(3):167–72.

    Google Scholar 

  32. Wang ZL, Miao RL, Gao C, Tang L, Li ZY, Sun YS, et al. Computed tomography arteriography for detecting the origin of the inferior pyloric artery in patients with gastric cancer. Korean J Radiol. 2019;20(3):422–8.

    Article  Google Scholar 

  33. Gangavatiker R, Pal S, Javed A, Dash NR, Sahni P, Chattopadhyay TK. Effect of antecolic or retrocolic reconstruction of the gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled trial. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(5):843–52.

    Article  Google Scholar 

  34. Eberlein TJ. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. Yearbook Surg. 2008;2008:364–5.

    Article  Google Scholar 

  35. Tan HT, Zong Y, Zhao ZQ, Wu LF, Jiang HC. Prognostic factors of postoperative delayed gastric emptying after pancreaticoduodenectomy: a predictive model. Zhonghua wai ke za zhi [Chinese J Surg]. 2017;55(5):368–72.

    CAS  Google Scholar 

  36. Yang DD, He K, Wu XL, Yang LK, Nie SF. Risk factors of gastroparesis syndrome after abdominal non-gastroduodenal operation and its prevention. Asian Pacific J Trop Med. 2013;6(6):497–9.

    Article  Google Scholar 

  37. Henegouwen M, Gulik T. Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg. 1997;185(4):373–9.

    Article  Google Scholar 

  38. Huang SH, Wang XJ, Deng Y, Jiang WZ, Huang Y, Chi P. Gastrocolic ligament lymph node dissection for transverse colon and hepatic flexure colon cancer: risk of nodal metastases and complications in a large-volume center. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2020. https://doi.org/10.1007/s11605-020-04705-4.

    Article  Google Scholar 

Download references

Acknowledgements

None.

Funding

This study was supported by the Fujian Minimally Invasive Medical Center Construction Project (No. 2017–171), Joint Funds for the innovation of Science and Technology, Fujian province (No. 2019Y9101; No. 2017Y9038), the Ethicon Excellence in Surgery Grant of Wu Jie** Medical Foundation (No.320.2710.1845, No.320.2710.1833), and the Healthcare Joint fund of Fujian Provincial Natural Science Foundation Projects (No. 2018J01183).

Author information

Author notes

  1. Yu Deng, Shenghui Huang and Ming** Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 **nquan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Yu Deng, Shenghui Huang, Ming** Huang, **aojie Wang, Ying Huang & Pan Chi

  2. Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, 29 **nquan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Shenghui Huang, Ming** Huang, **aojie Wang, Ying Huang & Pan Chi

Authors
  1. Yu Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shenghui Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming** Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. **aojie Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pan Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Protocol/project development: YD, SH, YH, PC. Data collection or management: YD, MH, XW. Data analysis: YD, SH, MH. Manuscript writing/editing: YD, SH, MH, X. W, YH, PC.

Corresponding authors

Correspondence to Ying Huang or Pan Chi.

Ethics declarations

Conflict of interests

We have no competing interests to declare.

Ethics approval and consent to participate

This study was subject to approval by the Institutional Review Board of Fujian Medical University Union Hospital (2018KY070). All patients provided written informed consent on admission.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deng, Y., Huang, S., Huang, M. et al. Gastrocolic ligament lymph-node dissection may increase the incidence of delayed gastric emptying after colon cancer surgery with D3 lymphadenectomy. Surg Today 51, 897–905 (2021). https://doi.org/10.1007/s00595-020-02200-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02200-6

Keywords

Search

Navigation