Abstract
Delayed gastric conduit emptying (DGCE) is a significant and prevalent complication following esophagectomy, adversely affecting recovery and quality of life. The true burden of DGCE remains uncertain due to considerable variability in reported incidence rates. This study aimed to determine the incidence of DGCE following esophagectomy and how this is impacted with varying diagnostic criteria. A systematic review was conducted across major databases, including PubMed, MEDLINE, Embase, Web of Science, and Cochrane, to identify studies reporting the incidence of DGCE following esophagectomy. The incidence rates were pooled and analyzed using a random-effects model, with subgroup analyses for potential sources of heterogeneity such as pyloric interventions, conduit dimensions, and anastomotic height. Among 5176 screened records, 125 studies met the eligibility criteria. The pooled incidence of early DGCE was 15.9% (95% CI 11-21%), and late DGCE was 9.4% (95% CI 7.1-11.9%). Significant heterogeneity was observed across studies, driven by variations in diagnostic methods. Subgroup analysis indicated that prophylactic pyloric drainage was not associated with a statistically significant effect on early DGCE (OR 0.76; p = 0.38) or late DGCE (OR 0.71; p = 0.44). DGCE represents a significant burden for esophageal cancer survivors, with considerable variability in its reported incidence, underscoring the urgent need for a standardized diagnostic criterion. The adoption of the recently published international consensus definition is crucial for reducing the heterogeneity, as well as improving the identification and management of DGCE.