Risk factors of delayed gastric emptying after distal pancreatectomy: A comprehensive systematic review and meta-analysis.

Background: Delayed gastric emptying (DGE) is a common complication after distal pancreatectomy (DP). However, its incidence and risk factors remain unclear. This meta-analysis aims to clarify the incidence and risk factors associated with DGE following DP.

Methods: We conducted a systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for studies on DGE after DP, covering publications up to July 4, 2024. Odds ratios (OR) and 95 % confidence intervals (95 %CI) were pooled using random-effects or fixed-effects models. And heterogeneity testing and bias assessment were conducted.

Results: A total of 82 studies involving 35,248 patients were included. The pooled analysis showed an incidence of DGE after DP of approximately 5.0 %. Among seven non-surgical risk factors, benign lesions as a protective factor for DGE after DP,while age over 75 was identified as potential risk factor for DGE after DP. Of the 21 surgical-related risk factors, early drain removal and laparoscopic distal pancreatectomy (LDP) were linked to a lower incidence of DGE, while factors such as hemorrhage, multivisceral resection, postoperative pancreatic fistula (POPF), portal vein resection, postoperative abscess, and wound infection were identified as potential risk factors for DGE after DP.

Conclusion: The incidence of DGE after DP is approximately 5.0 %. Risk factors include malignancy, open distal pancreatectomy (ODP), delayed drain removal, age over 75, hemorrhage, multivisceral resection, POPF, portal vein resection, postoperative abscess, and wound infection. This meta-analysis provides valuable insights for clinical practice, especially in improving the screening and management of high-risk patients. However, further large-scale, multicenter randomized controlled trials are needed to confirm these findings.