Preoperative Blood Glucose Level Predicts Postsurgical Gastroparesis Syndrome after Subtotal Gastrectomy: Development of an Individualized Usable Nomogram

Effects of perioperative ω-3 fish oil fat emulsion on postoperative gastric emptying function following Roux-en-Y reconstruction for gastric cancer

PURPOSE

Despite standardized surgical techniques, delayed gastric emptying (DGE) remains a major complication after Roux-en-Y reconstruction in patients with gastric cancer. This study aimed to evaluate the efficacy of ω-3 fish oil fat emulsion in reducing DGE incidence and improving postoperative outcomes.

METHODS

In this retrospective cohort study, 210 patients undergoing radical gastrectomy with Roux-en-Y reconstruction (Nanjing Drum Tower Hospital, 2018-2020) were stratified into 2 groups: the intervention group (n = 139) received parenteral nutrition (PN) with ω-3 fish oil emulsion (0.2 g/kg/d), whereas controls (n = 71) received standard PN. DGE diagnosis required persistent symptoms (>72 h postoperatively) and objective evidence of impaired motility (computed tomography contrast retention ≥ 50% at 4 h or scintigraphic T½ > 90 min), excluding mechanical obstructions (luminal stenosis < 8 mm).

RESULTS

The ω-3 group exhibited significantly lower DGE incidence (4.3% vs 15.5%; P =.005) and shorter median postoperative hospital stay (10 vs 13 days; P <.001). Multivariate analysis identified ω-3 supplementation as an independent protective factor against DGE (odds ratio, 0.32; 95% CI, 0.11-0.96; P =.042). Symptom severity (Gastroparesis Cardinal Symptom Index) showed progressive improvement in the ω-3 cohort, with significant reductions in nausea and vomiting scores by week 4 (P <.05).

CONCLUSION

Perioperative ω-3 fish oil fat emulsion supplementation reduces DGE risk by 71%, accelerates recovery, and improves surgical outcomes in patients with gastric cancer undergoing Roux-en-Y reconstruction. These findings support its integration into enhanced recovery protocols, particularly in high-risk populations.

Preoperative fasting glucose value can predict acute kidney injury in non-cardiac surgical patients without diabetes but not in patients with diabetes

BACKGROUND

Postoperative acute kidney injury (AKI) is a common and costly complication after non-cardiac surgery. Patients with or without diabetes could develop hyperglycemia before surgery, and preoperative hyperglycemia was closely associated with postoperative poor outcomes, but the association between preoperative fasting blood glucose level and postoperative AKI is still unclear.

METHODS

Data from patients undergoing non-cardiac surgery in Chongqing University Cancer Hospital from January 1, 2017, to May 31, 2023, were collected, preoperative glucose value and perioperative variables were extracted, the primary exposure of interest was preoperative glucose value, and the outcome was postoperative AKI.

RESULTS

Data from 39,986 patients were included in the final analysis, 741(1.9%) patients developed AKI, 134(5.6%) in the cohort with DM, and 607(1.6%) in the cohort without DM(OR 1.312, 95% CI 1.028-1.675, P = 0.029). A significant non-linear association between preoperative glucose and AKI exists in the cohort without DM after covariable adjustment (P = 0.000), and every 1 mmol/L increment of preoperative glucose level increased OR by 15% (adjusted OR 1.150, 95% CI 1.078-1.227, P = 0.000), the optimal cut-point of preoperative fasting glucose level to predict AKI was 5.39 mmol/L (adjusted OR 1.802, 95%CI 1.513-2.146, P = 0.000). However, in the cohort with DM, the relation between preoperative glucose and postoperative AKI was not significant after adjusting by covariables (P = 0.437). No significance exists between both cohorts in the risk of AKI over the range of preoperative glucose values.

CONCLUSION

A preoperative fasting glucose value of 5.39 mmol/L can predict postoperative acute kidney injury after non-cardiac surgery in patients without diagnosed diabetes, but it is not related to AKI in patients with the diagnosis.

Assessment of risk factors for delayed gastric emptying after distal gastrectomy for gastric cancer

The risk factors for delayed gastric emptying (DGE) following gastrectomy are unclear. This study aimed to investigate the risk factors for DGE and the severity of DGE. We retrospectively evaluated 412 patients who underwent gastrectomy for gastric cancer between 2011 and 2019. The cases were classified into the DGE (n = 27) and non-DGE (n = 385) groups; the DGE group was further classified into two subgroups based on nasogastric tube insertion as an indicator of severity. For determining the relationship between resected stomach volume and DGE, we calculated the area of each surgical specimen using the ImageJ software. Female sex (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.09–5.93; P = 0.03), diabetes (OR 2.38; 95% CI 1.02–5.57; P = 0.03), and distal gastric tumors (OR 2.61; 95% CI 1.10–6.19; P = 0.02) were identified as independent risk factors by multivariate analysis. The duration of hospital stay was longer in the DGE group than in the non-DGE group (29 vs. 15 days, P < 0.01). Overall, 24 cases of DGE (89%) were found in more than 1 week following surgery. No correlation was observed between clinical features and the severity of DGE. The resected area in the DGE group was significantly larger than that in the non-DGE group (198.0 vs. 173.9 cm², P = 0.03). In conclusion, DGE was frequently observed in females and in patients with diabetes and distal gastric tumors. Most of the DGE cases occurred after 7–14 days of surgery, patients who are discharged early should be informed to seek hospitalization if they have symptoms caused by DGE.