Delayed Gastric Emptying After Laparoscopic Left Hemicolectomy: Incidence, Clinical Course, and Operative-Field Extension

Abstract Background Delayed gastric emptying (DGE) after left hemicolectomy is uncommon and may be confused with diffuse postoperative ileus, fixed mechanical obstruction at the Treitz region, or an occult local functional disturbance. We characterised its incidence and clinical course and examined associations with tumour-location-related extension of the operative field and pathological features. Methods This single-centre retrospective cohort included consecutive adults who underwent laparoscopic left hemicolectomy between August 2019 and June 2026. DGE required persistent upper gastrointestinal symptoms, intolerance of oral intake, or a need for gastric decompression, together with computed-tomography exclusion of fixed mechanical obstruction and upper gastrointestinal contrast evidence of delayed gastric emptying. The proximal–extended operative-field phenotype comprised a tumour in the distal transverse colon near the splenic flexure, at the splenic flexure, or in the middle/upper descending colon, together with splenic-flexure mobilisation, inferior mesenteric vein root/high ligation, and Treitz-adjacent dissection. Fisher’s exact test, Wilson confidence intervals, and Firth penalised-likelihood logistic regression were used. Pathological and molecular analyses were exploratory. Results Among 379 eligible patients, 9 developed DGE (2.37%; 95% CI, 1.25%–4.45%); the median duration was 24 days (interquartile range, 18–26 days). All 9 events occurred in the proximal–extended operative-field group: 3.69% (9/244) versus 0% (0/135), yielding an absolute risk difference of 3.69 percentage points (95% CI, 0.42–6.86; P = 0.030). DGE occurred in 8.43% (7/83) of patients with pathological T4 disease and 0.68% (2/296) of those with T0–T3 disease (P < 0.001). In a Firth model containing both variables, the proximal–extended operative-field phenotype was associated with DGE (adjusted odds ratio [aOR], 14.75; 95% CI, 1.79–1922.10; P = 0.007), but the extremely wide interval indicates substantial uncertainty in the magnitude of this association. Pathological T4 stage was also associated with DGE (aOR, 14.01; 95% CI, 3.59–77.11; P < 0.001). Conclusions DGE after left hemicolectomy was uncommon and occurred only among patients with an extended operative field. The imprecise model estimate requires validation in larger cohorts and should not be interpreted as an independent causal effect of a single manoeuvre. Pathological T4 stage may mark local tumour burden and operative complexity rather than constitute a direct mechanism. Postoperative gastric retention should be differentiated among mechanical “pseudo-gastroparesis”, occult functional obstruction at the Treitz region, and stomach-predominant DGE.