Clinical significance and predictive factors of delayed gastric conduit emptying after esophagectomy

PURPOSE: Delayed gastric conduit emptying (DGCE) is a functional complication after esophagectomy that can cause nutritional and respiratory issues, but its risk factors remain unclear. METHODS: We retrospectively analyzed 166 patients after esophagectomy at Gifu University Hospital (2020-2024). DGCE was diagnosed per International Society for Diseases of the Esophagus criteria and graded using a novel radiographic classification (Grade 1-3). Clinical and postoperative outcomes were compared, and risk factors analyzed by logistic regression. RESULTS: DGCE occurred in 29 patients (17.5%). Early DGCE patients were more often female (p = 0.005), had greater gastric conduit-mediastinum length difference (p < 0.001), and fewer fixation sutures (p < 0.001). No independent predictors were identified, though female sex and higher body mass index (BMI) showed trends. Pneumonia and late DGCE were more frequent (both p < 0.001). Severe DGCE (Grade 3) caused greater weight loss at 6 months and 1 year (p = 0.013, p < 0.001). CONCLUSIONS: Post-esophagectomy DGCE was linked to excessive conduit length and insufficient fixation. Careful intraoperative handling and structured long-term follow-up are crucial.