Outcomes of Selective Versus Routine Gastric Tube Decompression After Gastrectomy for Gastric Cancer with Pyloric Obstruction: A Retrospective Cohort Study

<b>Background/Objectives</b>: The utility of routine gastric tube (GT) placement following gastrectomy in gastric cancer (GC) patients with pyloric obstruction remains controversial. This practice conflicts with Enhanced Recovery After Surgery (ERAS) principles, and its value in this high-risk subgroup is unclear. This study aimed to compare the clinical and economic outcomes of routine versus selective gastric tube use in these patients, and to identify predictors for prolonged gastric tube retention. <b>Methods</b>: A single-center retrospective cohort study was conducted on 133 GC patients with pyloric obstruction who underwent gastrectomy. Patients were stratified into GT (<i>n</i> = 63) and non-GT (<i>n</i> = 70) groups. Primary outcomes included 30-day complications, 90-day mortality, hospitalization duration, and costs. Univariate and multivariable Cox regression analyses were used to identify predictors of prolonged GT retention. <b>Results</b>: Routine GT use provided no clinical benefit, with similar 30-day complication (22.2% vs. 22.9%, <i>p</i> = 0.945) and 90-day mortality (1.6% vs. 0%, <i>p</i> = 0.290) rates. However, it was associated with a significantly prolonged postoperative hospital stay (8.8 ± 2.5 vs. 8.0 ± 4.2 days, <i>p</i> = 0.034) and a mean cost increase of ¥5900 per patient (<i>p</i> = 0.006). A dose-response relationship was evident: each additional day of GT retention correlated with 0.57 extra hospital days (r = 0.567, <i>p</i> < 0.001) and ¥3600 in added costs (r = 0.360, <i>p</i> = 0.004). Multivariable analysis identified longer preoperative fasting time (Adjusted HR = 1.27 per hour, 95% CI: 1.10-1.45, <i>p</i> = 0.001) and GLIM-defined malnutrition (Adjusted HR = 2.04, 95% CI: 1.02-4.17, <i>p</i> = 0.045) as independent predictors for prolonged GT retention. <b>Conclusions</b>: Routine GT placement after gastrectomy in obstructed GC patients increases healthcare costs and prolongs hospitalization without improving clinical outcomes. Preoperative fasting duration and nutritional status are key predictors for prolonged GT need. A selective GT strategy, guided by these parameters, is recommended to optimize recovery and resource utilization, aligning with ERAS principles.