Pathophysiology of Delayed Gastric Conduit Emptying After Oesophagectomy: A Multicentre Cohort Study

BACKGROUND: Delayed gastric conduit emptying (DGCE) is a common and functionally significant complication following oesophagectomy, yet its pathophysiology is incompletely understood. This study aimed to determine the incidence of early and late DGCE using standardised criteria and to identify independent predictors for each. METHODS: This multicentre retrospective cohort study included 272 consecutive patients who underwent oesophagectomy with gastric conduit reconstruction across three tertiary centres and two affiliated private hospitals between December 2014 and April 2025. DGCE was diagnosed using criteria adapted from the 2020 international expert consensus framework. Patients with late DGCE were further classified according to University Hospital Zurich's pathophysiological framework. Multivariable logistic regression was performed to identify independent predictors of early and late DGCE. RESULTS: The incidence of early and late DGCE was 19.3% and 19.6%, respectively. Open surgical approach was the sole independent predictor of early DGCE (OR 16.07, p = 0.032). Independent predictors of late DGCE included gastro-oesophageal junction tumour location (Oesophageal OR 0.37, p = 0.013) and the occurrence of postoperative complications (OR 4.67, p = 0.006). Classification of late DGCE cases revealed that functional antro-pyloric motility (Class I) was the most common subtype, typically manifesting in the first year after oesophagectomy. CONCLUSIONS: Early and late DGCE are distinct entities with differing risk profiles. These findings support the importance of distinguishing DGCE by timing and suspected underlying mechanism, and may help inform more targeted risk stratification, surveillance, and management strategies after oesophagectomy.