Skip to main content

Delayed Gastric Emptying After Multivisceral Resection for Retroperitoneal Sarcoma



Delayed gastric emptying (DGE) is a common complication in surgery, but incidence and relevance following multivisceral resection are unknown.


Data from 100 consecutive patients treated for primary retroperitoneal sarcoma (RPS) were analyzed from our institutional prospectively maintained database from January 2019 to April 2020. DGE severity was graded according to the International Study Group of Pancreatic Surgery and classified as primary or secondary to other complications. The primary outcome was incidence and grade of clinically relevant DGE (grades B–C). Secondary outcomes were correlation with patient, tumor, and treatment characteristics, and non-DGE morbidity [Clavien-Dindo (CD) grade ≥ 3].


Forty-two patients developed DGE and 28 had clinically relevant DGE. DGE was primary in 10 patients and secondary in 18 patients; the most common associated complications were: infections (11/18, 61.1%), pancreatic leak (7/18, 38.9%), bleeding (6/18, 33.3%), and bowel leak (6/18, 33.3%). DGE was related to longer length of hospital stay (P < 0.001), ICU admission (P = 0.004), ICU length of stay (P = 0.001), postoperative complications (CD \(\ge\) 3 in 14/28 in DGE patients vs 11/72 in no-DGE; P = 0.04), and re-operation (P = 0.03). With multivariate analysis, the independent risk factors for DGE were patient comorbidities (OR 1.05; 95% CI 1.01–1.1; P = 0.04) and tumor size (OR 1.05; 95% CI 1.0–1.1; P = 0.02).


Following multivisceral resection, DGE is a clinically relevant event that can be caused by an underlying complication. Prompt diagnosis and treatment of both DGE and any underlying complications led to full recovery in all cases.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Wente MN, Bassi C, Dervenis C, 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 

  2. Callegaro D, Raut CP, Ng D, et al. Has the Outcome for Patients Who Undergo Resection of Primary Retroperitoneal Sarcoma Changed Over Time? A Study of Time Trends During the Past 15 years. Ann Surg Oncol. 2021;28(3):1700–9.

    Article  Google Scholar 

  3. MacNeill AJ, Fiore M. Surgical morbidity in retroperitoneal sarcoma resection. J Surg Oncol. 2018;117(1):56–61.

    Article  Google Scholar 

  4. Swallow CJ, Strauss DC, Bonvalot S, et al. Management of primary retroperitoneal sarcoma (RPS) in the adult: an updated consensus approach from the Transatlantic Australasian RPS Working Group. Ann Surg Oncol. 2021;28:7873–88.

  5. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  6. Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. Br J Surg. 1998 85(9):1217-20.

  7. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” ('MUST’) for adults. Br J Nutr. 2004;92(5):799–808.

    Article  CAS  Google Scholar 

  8. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001–5.

    CAS  PubMed  Google Scholar 

  9. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997–1006.

    Article  Google Scholar 

  10. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.

    Article  Google Scholar 

  11. Baker C, Ahmed M, Cheng K, et al. Hypoganglionosis in the gastric antrum causes delayed gastric emptying. Neurogastroenterol Motil. 2020 32(5):e13766.

  12. Klaiber U, Probst P, Strobel O, et al. Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy. Br J Surg. 2018;105(4):339–49.

    Article  CAS  Google Scholar 

  13. Shaikh N, Nainthramveetil MM, Nawaz S, et al. Optimal dose and duration of enteral erythromycin as a prokinetic: A surgical intensive care experience. Qatar Med J. 2021;2020(3):36.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Peng R, Li H, Yang L, et al. The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis. PLoS One. 2021;16(1):e0245317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Taylor SJ, Allan K, McWilliam H, et al. A randomised controlled feasibility and proof-of-concept trial in delayed gastric emptying when metoclopramide fails: We should revisit nasointestinal feeding versus dual prokinetic treatment: Achieving goal nutrition in critical illness and delayed gastric emptying: Trial of nasointestinal feeding versus nasogastric feeding plus prokinetics. Clin Nutr ESPEN. 2016;14:1–8.

    Article  PubMed  Google Scholar 

  16. Cai X, Zhang M, Liang C, Xu Y, Yu W. Delayed gastric emptying after pancreaticoduodenectomy: a propensity score-matched analysis and clinical nomogram study. BMC Surg. 2020;20(1):149.

    Article  Google Scholar 

  17. Previtali P, Fiore M, Colombo J, Arendar I, Fumagalli L, Pizzocri M, Colombo C, Rampello NN, Mariani L, Gronchi A, Codazzi D. Malnutrition and Perioperative Nutritional Support in Retroperitoneal Sarcoma Patients: Results from a Prospective Study. Ann Surg Oncol. 2020;27(6):2025–32.

    Article  Google Scholar 

  18. Kirov KM, Xu HP, Crenn P, et al. Role of nutritional status in the early postoperative prognosis of patients operated for retroperitoneal liposarcoma (RLS): A single center experience. Eur J Surg Oncol. 2019;45(2):261–7.

    Article  Google Scholar 

Download references


No funding has been used for this publication

Author information

Authors and Affiliations


Corresponding author

Correspondence to Marco Fiore MD, FACS.

Additional information

Publisher's Note

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

This paper is not based on a previous communication to a society or meeting.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Baia, M., Conti, L., Pasquali, S. et al. Delayed Gastric Emptying After Multivisceral Resection for Retroperitoneal Sarcoma. Ann Surg Oncol 29, 3264–3270 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: