Published online Sep 27, 2026. doi: 10.4240/wjgs.120780
Revised: May 24, 2026
Accepted: June 24, 2026
Published online: September 27, 2026
Processing time: 157 Days and 23.5 Hours
Gastric cancer is among the most common digestive tract malignancies world
To analyze independent risk factors of delayed gastrointestinal recovery in pati
A total of 293 patients who underwent radical gastrectomy in our hospital between January 2021 and July 2025 were retrospectively analyzed. On the basis of postoperative gastrointestinal recovery status, patients were divided into a normal group (218 cases) and a delayed group (75 cases). General information, preoperative lab indicators, tumor-related data, and surgery-related data were collected. Independent risk factors were screened by univariate and multivariate logistic regression analysis. A Nomogram prediction model was established according to multivariate analysis results. Discrimination, calibration and clinical value of the models were assessed using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves and decision curve analysis (DCA). Validation: Internal validation was performed by the Bootstrap method (1000 repeated samplers).
Among 293 patients, delayed gastrointestinal recovery occurred in 75 cases (25.6%). Multivariate logistic regression analysis revealed that age ≥ 65 years [odds ratio (OR) = 2.18, 95%CI: 1.14-4.17, P = 0.018], underweight (OR = 2.87, 95%CI: 1.38-5.97, P = 0.005), American Society of Anesthesiologists (ASA) grade III (OR = 2.42, 95%CI: 1.28-4.58, P = 0.007), preoperative hypoalbuminemia (OR = 2.53, 95%CI: 1.31-4.89, P = 0.006), tumour, node, and metastasis (TNM) stage III (OR = 2.15, 95%CI: 1.14-4.06, P = 0.018) and total gastrectomy (OR = 3.28, 95%CI: 1.65-6.52, P = 0.001) were independent risk factors for delayed gastrointestinal recovery. The Nomogram prediction model constructed based on the above 6 factors had an area under the ROC curve (AUC) of 0.802 (95%CI: 0.747-0.857); the Hosmer-Lemeshow test yielded χ2 = 6.823 (P = 0.556); DCA showed that the model had net benefit within a threshold probability range of 0.10-0.75; the corrected C-index after Bootstrap internal validation was 0.793 (95%CI: 0.736-0.850).
Age ≥ 65 years, underweight, ASA grade III, preoperative hypoalbuminemia, TNM stage III and total gastrectomy are independent risk factors for delayed gastrointestinal recovery after radical gastrectomy. The nomogram prediction model established in this study has good discriminatory and calibration ability and clinical usefulness, that can preoperatively identify high-risk patients, which provides a scientific basis for formulating individualized perioperative management strategies.
Core Tip: Gastrointestinal recovery is crucial after radical gastrectomy; however, delayed gastrointestinal recovery is a common complication following surgery, affecting postoperative outcomes. Age ≥ 65 years, underweight status, American Society of Anesthesiologists (ASA) grade III, preoperative hypoalbuminemia, tumour, node, and metastasis (TNM) stage III and total gastrectomy were all identified as independent risk factors in this retrospective cohort study. After Bootstrap validation, a Nomogram including these variables showed good discrimination, calibration and clinical utility. Five of the six predictors (age, body mass index, ASA grade, serum albumin, and TNM stage) are identifiable preoperatively within a standard diagnostic workup, while total gastrectomy is determined intraoperatively. This accessibility enables early preoperative risk stratification and guides individualised perioperative management. Application of this approach may help to optimize nutritional intervention, ameliorate surgical planning and contribute to improvement in enhanced recovery after surgery inductees allowing for an expedited return of gastrointestinal activity along with prognostically favorable outcomes for the patient.