Assessment of gastric emptying using 13C-acetate breath test with semi-solid diet after gastric cancer surgery and strategies for nutritional guidance

Postgastrectomy syndrome following gastric cancer surgery remains a major concern in digestive surgery. This study aimed to investigate the mechanisms and timing of postgastrectomy syndrome based on surgical procedures and reconstruction methods in gastric cancer surgery and integrate these data to facilitate individualized perioperative nutritional guidance for patients. A total of 95 patients who underwent gastrectomy for gastric cancer between April 2021 and July 2024 and with preoperative and 1 month postoperative data were included in the analysis; 20 healthy individuals served as controls. A novel semi-solid test meal integrated with a 13 C-acetate breath test was used to evaluate gastric-emptying capabilities in patients. Gastric half-emptying times (T1/2) were quantitatively assessed using the Wagner-Nelson analysis. The median preoperative T1/2 in patients with gastric cancer was 42.0 min, which was significantly delayed compared with that in healthy controls, who had a median T1/2 of 36.8 min ( p = 0.034). Postoperatively, the median T1/2 was further delayed to 45.9 min ( p = 0.044). When analyzed by surgical technique, patients who underwent distal gastrectomy with Billroth I reconstruction had a median T1/2 of 54.9 min, whereas those who underwent distal gastrectomy and Roux-en-Y reconstruction had a median T1/2 of 70.5 min. In contrast, the group who underwent proximal gastrectomy with modified side overlap esophagogastrostomy had a markedly shorter median T1/2 of 26.3 min. This study confirmed delayed gastric emptying in patients with gastric cancer even before surgery and indicates that the choice of surgical technique and reconstruction method significantly influences postoperative gastric function.