OBJECTIVETo investigate the risk factors of prolonged postoperative ileus (PPOI) after gastric cancer surgery.

METHODSDefinition of PPOI was that gastrointestinal function did not return to normal within 96 hours after operation. Diagnostic criteria of PPOI were as follows: according with over 2 below conditions at postoperative 97-hour: (1) moderate to severe sick (mild: 1-3 points, moderate: 4-7 points, severe: 8-10 points) or vomiting occurred in past 12 hours. (2) patient was intolerable of solid food in the last 2 meals and reported the food-intake as less than 25%. (3) no flatus and defecation occurred in past 24 hours. (4) moderate to severe abdominal distension was diagnosed by doctor with knocking abdomen. (5) iconography examination (abdominal X-ray or CT) in past 24 hours revealed gastrectasis, gas-fluid plane, intestinal or colorectal loop extension, indicating the ileus. A total of 83 patients with gastric carcinoma confirmed by preoperative gastroscopic pathology undergoing operation at the Department of General Surgery, Chinese PLA General Hospital from August 2016 to October 2016 were prospectively enrolled in the study. The incidence and risk factors of PPOI after gastric cancer surgery were calculated and analyzed with univariate and logistic regression multivariate analyses.

RESULTSOf 83 gastric cancer patients, 62 were male and 21 were female with an average age of (60.1±11.0)(39-89) years. Postoperative pathology showed 41 cases with III(-IIII( stage, 42 cases with I(-II( stage. According to the above diaguostic criteria, 22(26.5%) patients were diagnosed as PPOI postoperatively. Among 22 cases, 3 cases had no flatus and defecation with moderate-severe sick and vomiting within postoperative 96 hours; 15 cases had no flatus and defecation with moderate-severe abdominal extension within postoperative 96 hours; 4 cases had no flatus and defecation with moderate-severe sick, vomiting and moderate-severe abdominal extension within postoperative 96 hours. Clinical symptoms of all the POOI patients were improved following conservative treatment. Univariate analysis showed that age ≥65 years[13/26(50.0%) vs. 9/57(15.8%), χ=10.727, P=0.001], postoperative body temperature ≥38.0centi-degree [8/17(47.1%) vs. 14/66(21.2%), χ=4.636, P=0.031], postoperative serum potassium level[20/81(24.7%) vs. 2/2, χ=5.682, P=0.017], and use of opioid agent Dezocine [15/38(39.5%) vs. 7/45(15.6%), χ=6.050, P=0.014] were associated with POOI. Logistic regression analysis showed that age ≥65 years (OR=17.415, 95%CI:17.151-17.750, P=0.015), postoperative body temperature ≥38centi-degree(OR=15.855, 95%CI:15.422-16.214, P=0.013), use of Dezocine after surgery (OR=21.379, 95%CI:20.814-21.654, P=0.010) were the independent risk factors of PPOI after gastric cancer surgery.

CONCLUSIONGastric patients with older age, increased body temperature and the use of Dezocine after surgery have higher risk of POOI and need special perioperative management and treatment.