Celiac ganglion resection as an intraoperative factor associated with delayed gastric emptying in retroperitoneal sarcoma surgery: A multicentric prospective cohort study

Abstract

Introduction

Delayed gastric emptying (DGE) is a common but underexplored complication following retroperitoneal sarcoma surgery. The celiac ganglion, often excised during these procedures, plays a key role in gastric motility and its removal may contribute to DGE development.

Materials and methods

Data from 42 patients were prospectively collected at three referral centers. DGE was graded according to the International Study Group of Pancreatic Surgery (ISGPS) classification. Intraoperative celiac ganglion resection was categorized as none, partial, or complete. The primary endpoint was the effect of celiac ganglion resection on clinically relevant DGE (ISGPS grade B–C). The secondary endpoint was whether resection was an independent predictor of DGE.

Results

One patient was excluded due to early postoperative mortality. Among the remaining 41 patients, DGE occurred in 60.97 % of cases, with 26.83 % classified as clinically relevant. Partial celiac ganglion resection was performed in 31.7 % of patients, while complete resection occurred in 14.6 %. Univariate analysis showed that complete resection was associated with 22.5-fold increased risk of clinically relevant DGE (p = 0.011). Multivariate analysis confirmed this association, identifying complete resection as an independent risk factor (OR = 40.56, p = 0.013).

Conclusions

Clinically relevant DGE is frequent after retroperitoneal sarcoma surgery. Complete celiac ganglion resection significantly increases the risk of DGE, emphasizing the importance of careful surgical planning and comprehensive preoperative patient counselling. Implementing standardized perioperative protocols, including early nutritional support, may help mitigate its impact and improve postoperative recovery.