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Incidence of adhesive small bowel obstruction after gastrectomy for gastric cancer and its risk factors: a long-term retrospective cohort study from a high-volume institution in China

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Abstract

Adhesive small bowel obstruction (ASBO) has a significant impact on quality of life and medical costs. However, data about ASBO after gastrectomy remain sparse. From January 2009 to December 2017, 3025 patients who underwent gastrectomy for gastric cancer were retrospectively collected and analyzed. Clinicopathological materials were obtained retrospectively, and univariate and multivariate regression analyses were performed to determine risk factors for ASBO. A nomogram for the prediction of ASBO was generated using the results of multivariable analyses. Bootstraps with 1000 resamples were performed for internal validation. The performance of the model was assessed with its discrimination, calibration, and clinical usefulness. A total of 330 (10.9%) patients experienced at least one ASBO episode with a median follow-up of 57.0 (interquartile range 31.0–85.0) months. Logistic regression analysis showed that independent risk factors for ASBO were previous abdominal surgery (odds ratio, OR = 2.03), open gastrectomy (OR = 3.12), non-Billroth-1 reconstruction (Billroth-2, OR = 2.61; Roux-en-Y, OR = 1.99; esophagogastrostomy, OR = 2.79), D2/D2 + lymphadenectomy (OR = 2.64), combined organ resection (OR = 2.76), and postoperative intraabdominal complication (OR = 2.73). The nomogram showed good discrimination, with a C-index of 0.702 and good calibration. Decision curve analysis demonstrated that the nomogram was clinically useful. Several risk factors associated with ASBO after gastrectomy for gastric cancer were identified. Nomogram generated based on these factors could serve as a reliable tool to predict the probability of ASBO.

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Acknowledgements

The authors would like to thank the substantial work of Volunteer Team of Gastric Cancer Surgery (VOLTGA), West China Hospital, Sichuan University, China, for the establishment and updating of gastric cancer database.

Funding

Foundation of Science & Technology Department of Sichuan Province (2019YFS0255); The Ten Thousand Talent Program of Sichuan Province (No. 101); 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University, No. ZY2017304.

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  1. Tao Pan, Danil Galiullin, and Xiao-Long Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China

    Tao Pan, Danil Galiullin, Xiao-Long Chen, Wei-Han Zhang, Kun Yang, Kai Liu, Lin-Yong Zhao, Xin-Zu Chen & Jian-Kun Hu

  2. Department of Urology, Bashkir State Medical University, Ufa, Russian Federation

    Danil Galiullin

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Contributions

JKH, TP, XLC, and DG made substantial contributions to conception and design for this study. TP, XLC, and DG, KL, and WHZ acquired and analyzed data and Tao Pan drafted the article. KY, XZC, and JKH provided a large number of cases and gave many important suggestions for this study. They also participated in writing the paper. TP, LYZ, KL, XZC, WHZ, XLC, and KY also participated in revising it critically for important intellectual content; TP, XLC, and DG contributed equally to this work. JKH gave the final approval of the version to be published.

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Correspondence to Jian-Kun Hu.

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Disclosures Tao Pan, Danil Galiullin, Xiao-long Chen, Wei-han Zhang, Kun Yang, Kai Liu, Lin-yong Zhao, Xin-zu Chen, and Jian-kun Hu have no conflicts of interest or financial ties to disclose.

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Pan, T., Galiullin, D., Chen, XL. et al. Incidence of adhesive small bowel obstruction after gastrectomy for gastric cancer and its risk factors: a long-term retrospective cohort study from a high-volume institution in China. Updates Surg 73, 615–626 (2021). https://doi.org/10.1007/s13304-021-00983-y

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