Risk factors analysis and construction of a nomogram prediction model for reflux esophagitis after proximal gastrectomy

Abstract:

Background and Aims Proximal gastrectomy is an important surgical procedure for upper gastric cancer; however, postoperative reflux esophagitis (RE) remains a common complication that significantly affects patients' quality of life. Few studies have investigated the risk factors and prediction models for RE after proximal gastrectomy. This study aimed to identify independent risk factors for postoperative RE and to construct and validate a nomogram for individualized risk prediction.Methods A total of 100 patients with gastric cancer who underwent radical proximal gastrectomy between October 2022 and October 2024 were enrolled. Patients were divided into the RE group and the non-RE group according to the occurrence of RE during the 6-month follow-up. Clinical characteristics, tumor-related factors, surgical factors, and postoperative complications were compared between groups. Independent risk factors for postoperative RE were identified using univariate analysis and multivariate Logistic regression analysis. A nomogram model was developed based on independent risk factors and evaluated using receiver operating characteristic (ROC) curve analysis, the Hosmer-Lemeshow (H-L) test, and decision curve analysis.Results Among the 100 patients, 24 (24.0%) developed postoperative RE. Significant differences were observed between the RE and non-RE groups regarding digestive tract reconstruction methods, esophageal resection length, and postoperative gastric emptying disorder (all P<0.05). Multivariate Logistic regression analysis demonstrated that anterior esophagogastric anastomosis (OR=5.842, 95% CI=4.621-7.062), longer esophageal resection length (OR=2.735, 95% CI=1.023-4.446), and postoperative gastric emptying disorder (OR=3.136, 95% CI=1.035-5.237) were independent risk factors for postoperative RE. The nomogram model showed good predictive performance, with an area under the ROC curve (AUC) of 0.784 (95% CI=0.701-0.858). The H-L test indicated good calibration (χ²=1.434, P=0.261), and decision curve analysis demonstrated favorable clinical utility.Conclusion Digestive tract reconstruction methods, esophageal resection length, and postoperative gastric emptying disorder are independent risk factors for RE after proximal gastrectomy. The proposed nomogram model may provide an effective tool for risk stratification and individualized prevention of postoperative RE.