{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:48:23Z","timestamp":1780440503813,"version":"3.54.1"},"reference-count":16,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003645","name":"National Cancer Center of the Republic of Korea","doi-asserted-by":"publisher","award":["2311380-3"],"award-info":[{"award-number":["2311380-3"]}],"id":[{"id":"10.13039\/501100003645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as \u201cnearly normal diet residue\u201d at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21\/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014\u20130.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients.<\/jats:p>","DOI":"10.3390\/cancers17152527","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:09:27Z","timestamp":1753891767000},"page":"2527","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors for Long-Term Delayed Gastric Emptying and Its Impact on the Quality of Life After Laparoscopic Pylorus-Preserving Gastrectomy in Patients with Gastric Cancer: Secondary Analysis of the Prospective Multicenter Trial KLASS-04"],"prefix":"10.3390","volume":"17","author":[{"given":"Young Shick","family":"Rhee","sequence":"first","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6252-7532","authenticated-orcid":false,"given":"Sang Soo","family":"Eom","sequence":"additional","affiliation":[{"name":"Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang 10380, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bang Wool","family":"Eom","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Biostatistics Collaboration Team Research Institute, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa-Hong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9530-647X","authenticated-orcid":false,"given":"Hyuk-Joon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Woo","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Kwang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9644-6127","authenticated-orcid":false,"given":"Do Joong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"},{"name":"Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5615-4162","authenticated-orcid":false,"given":"Sang Uk","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Ajou University, Suwon 16499, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung-Ho","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo Jin","family":"Hyung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yonsei University Severance Hospital, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Ho","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gyeongsang National Univeristy College of Medicine, Jinju 52727, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Suhk","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"},{"name":"Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oh Kyoung","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cheju Halla General Hospital, Jeju City 63127, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Kyu","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chonnam National University Medical School, Hwasun 58128, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Man","family":"Yoon","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Hoon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3929-796X","authenticated-orcid":false,"given":"Seong-Ho","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keun Won","family":"Ryu","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.5230\/jgc.2022.22.e21","article-title":"Epidemiology of Gastric Cancer in Korea: Trends in Incidence and Survival Based on Korea Central Cancer Registry Data (1999\u20132019)","volume":"22","author":"Park","year":"2022","journal-title":"J. Gastric Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"115","DOI":"10.5230\/jgc.2025.25.e8","article-title":"Korean Gastric Cancer Association-Led Nationwide Survey on Surgically Treated Gastric Cancers in 2023","volume":"25","author":"Kim","year":"2025","journal-title":"J. Gastric Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.3748\/wjg.v22.i3.1101","article-title":"Quality of life: A critical outcome for all surgical treatments of gastric cancer","volume":"22","author":"McCall","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/SLA.0000000000006503","article-title":"Laparoscopic Pylorus Preserving Gastrectomy versus Distal Gastrectomy for Early Gastric Cancer; A Multicenter Randomized Controlled Trial (KLASS-04)","volume":"281","author":"Lee","year":"2024","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10120-007-0434-7","article-title":"Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer","volume":"10","author":"Nunobe","year":"2007","journal-title":"Gastric Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1007\/s00268-012-1491-6","article-title":"Current Status of Pylorus-Preserving Gastrectomy for the Treatment of Gastric Cancer: A Questionnaire Survey and Review of Literatures","volume":"36","author":"Shibata","year":"2012","journal-title":"World J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s00423-016-1529-6","article-title":"Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy","volume":"402","author":"Kiyokawa","year":"2017","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1046\/j.1365-2168.2002.01984.x","article-title":"Length of the antral segment in pylorus-preserving gastrectomy","volume":"89","author":"Nakane","year":"2002","journal-title":"Br. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1097\/SLA.0b013e3182117b24","article-title":"Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer","volume":"253","author":"Jiang","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Camilleri, M., Chedid, V., Ford, A.C., Haruma, K., Horowitz, M., Jones, K.L., Low, P.A., Park, S.-Y., Parkman, H.P., and Stanghellini, V. (2018). Gastroparesis. Nat. Rev. Dis. Primers, 4.","DOI":"10.1038\/s41572-018-0038-z"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s101200200014","article-title":"Endoscopic evaluation of the remnant stomach after gastrectomy: Proposal for a new classification","volume":"5","author":"Kubo","year":"2002","journal-title":"Gastric Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.cgh.2020.10.045","article-title":"Constipation in Patients With Symptoms of Gastroparesis: Analysis of Symptoms and Gastrointestinal Transit","volume":"20","author":"Parkman","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"310","DOI":"10.4174\/astr.2017.93.6.310","article-title":"Clinical features of gastric emptying after distal gastrectomy","volume":"93","author":"Kim","year":"2017","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s10120-014-0337-3","article-title":"Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: Technical report and surgical outcomes","volume":"18","author":"Kumagai","year":"2015","journal-title":"Gastric Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"135","DOI":"10.5230\/jgc.2022.22.e16","article-title":"Short-term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer: Comparison Between Extracorporeal and Intracorporeal Gastrogastrostomy","volume":"22","author":"Alzahrani","year":"2022","journal-title":"J. Gastric Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/15\/2527\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:19:25Z","timestamp":1760033965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/15\/2527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":16,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["cancers17152527"],"URL":"https:\/\/doi.org\/10.3390\/cancers17152527","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,30]]}}}