Enteral Feeding Access Has an Impact on Outcomes for Patients with Esophageal Cancer Undergoing Esophagectomy: An Analysis of SEER-Medicare

Lorimer, Patrick D.; Motz, B.; Watson, Michael; Trufan, Sally J.; Prabhu, Roshan S.; Hill, Joshua S.; Salo, Jonathan C.

doi:10.1245/s10434-019-07230-0

Cited by 17 publications

(13 citation statements)

References 33 publications

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“…Using the Surveillance Epidemiology and End Results-Medicare (SEER) database, Lorimer et al[39] found that in patients who underwent esophagectomy, mortality was lower and short-term survival was improved at 90 d with an overall shorter length of hospital stay in patients with a j-tube. Enteral feeding via jejunostomy appears to be associated with improved patient outcomes and allows for early establishment of enteral nutrition for eventual transition to an oral diet, which can be managed in an outpatient setting.…”

Section: Methods Of Artificial Feeding After Esophagectomymentioning

confidence: 99%

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Zheng

Devin

Pucci

et al. 2019

WJG

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Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.

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Section: Methods Of Artificial Feeding After Esophagectomymentioning

confidence: 99%

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Zheng

Devin

Pucci

et al. 2019

WJG

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“…Intraoperative placement of feeding jejunal tube (FJT) offers a route for enteral nutrition (EN) to bridge the very first postoperative period to a safer stage for oral diet. Despite its extensive use and popularity, the risks and benefits of FJT in patients with esophageal cancer (ESCA) remain controversial (7)(8)(9)(10)(11). In prior studies, FJT has been associated with reduced length of hospital stay, and possibly with improved short-term mortality (8,12).…”

Section: Introductionmentioning

confidence: 99%

“…Despite its extensive use and popularity, the risks and benefits of FJT in patients with esophageal cancer (ESCA) remain controversial (7)(8)(9)(10)(11). In prior studies, FJT has been associated with reduced length of hospital stay, and possibly with improved short-term mortality (8,12). In the presence of anastomotic leakage, a lower risk for severe morbidity was also observed in patients with FJT (13).…”

Section: Introductionmentioning

confidence: 99%

Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage

Zhuang¹,

Wu²,

Liu³

et al. 2021

J Gastrointest Oncol

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Background: Feeding jejunostomy is widely used for enteral nutrition (EN) after esophagectomy; however, its risks and benefits are still controversial. We aimed to evaluate the short-term and long-term outcomes of feeding jejunal tube (FJT) in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) who were deemed high-risk for anastomotic leakage.Methods: We retrospectively analyzed 716 patients who underwent esophagectomy with (FJT group, n=68) or without (control group, n=648) intraoperative placement of FJT. Propensity score matching (PSM) was used for the adjustment of confounding factors. Risk level for anastomotic leakage was determined for every patient after PSM.Results: Patients in the FJT group were at higher risk of anastomotic leakage (14.9% vs. 11.3%), and had a statistically non-significant increase of postoperative complications [31.3% vs. 21.8%, odds ratio (OR) =1.139, 95% confidence interval (CI), 0.947-1.370, P=0.141] after PSM. Medical expenditure, length of postoperative hospital stay, and short-term mortality were similar between the FJT and control groups. Placement of FJT appeared to accelerate the recovery of anastomotic leakage (27.2 vs. 37.4 d, P=0.073). Patients in FJT group achieved comparable overall survival (OS) both before [hazard ratio (HR) =0.850, P=0.390] and after (HR =0.797, P=0.292) PSM.Conclusions: FJT showed acceptable safety profile along with potential benefits for ESCC patients with a high presumed risk of anastomotic leakage. While FJT does not impact OS, placement of FJT should be considered in esophagectomy patients and tailored to individual patients based on their leak-risk profile.

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“…This mortality benefit has been corroborated by a study performed by Lorimer et al using the Surveillance Epidemiology and End Results (SEER) database, which found that the majority of their patients e all 65 years of age and older e received j-tubes during esophagectomy, and that mortality among those with j-tubes was lower at 30, 60, and 90 days after esophagectomy with a correspondingly lower length of stay. 12 Based on their data, the authors recommended routine j- tube placement during esophagectomy as the standard of care. We can similarly describe that j-tubes are associated with a mortality benefit without an increase in inpatient resource utilization, although a causal effect cannot be assumed; while we may presume that patients with j-tubes were likely to receive some form of supplemental enteral nutrition, we can neither confirm this nor infer the type, duration, or frequency of enteral feeding actually given.…”

Section: Discussionmentioning

confidence: 99%

Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

Zheng

Rios-Diaz

Liem

et al. 2021

The American Journal of Surgery

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Background: Patients undergoing esophagectomy often receive jejunostomy tubes (j-tubes) for nutritional supplementation. We hypothesized that j-tubes are associated with increased postesophagectomy readmissions. Study design: We identified esophagectomies for malignancy with (EWJ) or without (EWOJ) j-tubes using the 2010e2015 Nationwide Readmissions Database. Outcomes include readmission, inpatient mortality, and complications. Outcomes were compared before and after propensity score matching (PSM). Results: Of 22,429 patients undergoing esophagectomy, 16,829 (75.0%) received j-tubes. Patients were similar in age and gender but EWJ were more likely to receive chemotherapy (24.2% vs. 15.1%, p < 0.01). EWJ was associated with decreased 180-day inpatient mortality (HR 0.72 [0.52e0.99]) but not with higher readmissions at 30-(15.2% vs. 14.0%, p ¼ 0.16; HR 0.9 [0.77e1.05]) or 180 days (25.2% vs. 24.3%, p ¼ 0.37; HR 0.94 [0.79e1.10]) or increased complications (p ¼ 0.37). These results were confirmed in the PSM cohort. Conclusion: J-tubes placed in the setting of esophagectomy do not increase inpatient readmissions or mortality.

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Enteral Feeding Access Has an Impact on Outcomes for Patients with Esophageal Cancer Undergoing Esophagectomy: An Analysis of SEER-Medicare

Cited by 17 publications

References 33 publications

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage

Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

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