Feeding jejunostomy tube placement during resection of gastric cancers

Abstract

Background Feeding tube placement is common among patients undergoing gastrectomy, and national guidelines currently recommend consideration of a feeding jejunostomy tube (FJT) for all patients undergoing resection for gastric cancer. However, data are limited regarding the safety of FJT placement at the time of gastrectomy for gastric cancer. Methods The 2005–2011 American College of Surgeons National Surgical Quality Improvement Program Participant User Files were queried to identify patients who underwent gastrectomy for gastric cancer. Subjects were classified by the concomitant placement of an FJT. Groups were then propensity matched using a 1:1 nearest neighbor algorithm, and outcomes were compared between groups. The primary outcomes of interest were overall 30-d overall complications and mortality. Secondary end points included major complications, surgical site infection, and early reoperation. Results In total, 2980 subjects underwent gastrectomy for gastric cancer, among whom 715 (24%) also had an FJT placed. Patients who had an FJT placed were more likely to be male (61.6% versus 56.6%, P = 0.02), have recent weight loss (21.0% versus 14.8%, P < 0.01), and have undergone recent chemotherapy (7.9% versus 4.2%, P < 0.01) and radiation therapy (4.2% versus 1.3%, P < 0.01). They were also more likely to have undergone total (compared with partial) gastrectomy (66.6% versus 28.6%, P < 0.01) and have concomitant resection of an adjacent organ (40.4 versus 24.1%, P < 0.01). After adjustment with propensity matching, however, all baseline characteristics and treatment variables were highly similar. Between groups, there were no statistically significant differences in 30-d overall complications (38.8% versus 36.1%, P =0.32) or mortality (5.8 versus 3.7%, P =0.08). There were also no differences in major complications, surgical site infection, or early reoperation. Operative time was slightly longer among patients with feeding tubes placed (median, 248 versus 233 min, P = 0.01), but otherwise there were no significant differences in any outcomes between groups. Conclusions Concomitant placement of FJT at the time of gastrectomy may result in slightly increased operative times but does not appear to lead to increased perioperative morbidity or mortality. Further investigation is needed to identify the patients most likely to benefit from FJT placement.

Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

“…Notably, jejunostomy fed patients in this study observed lower rates of undernutrition postoperatively and greater postoperative improvements in Karonofsky performance scores when compared with jejunostomy free patients. The data of Sun et al, by far the largest retrospective compilation of gastrectomy patient outcomes, noted no statistically significant differences in 30-day patient mortality, major complication rate, overall complication rate, or infection between jejunostomy and jejunostomy free patients [27].…”

“…Aside from a slightly longer operative time for jejunostomy patients, the authors noted no statistically significant differences in mortality, overall complications, or any of the secondary outcomes. Jejunostomy group patients did experience higher rates of urinary tract infections 6.4% to 3.4% (p < 0.05) [27]. The authors postulated that a potential longer duration of catheterisation to monitor fluid balance may have been …”

“…partial vs. total gastrectomy) [27]. Of the 2980 patients, 71.4% underwent partial gastrectomy and 28.6% underwent total gastrectomy (Table 3).…”

“…Patients who received a jejunostomy tube were more likely to have recent weight loss, have undergone recent chemotherapy and radiotherapy, and more likely to have undergone total gastrectomy (p < 0.05) [27]. These factors may demonstrate that surgeons typically reserve the insertion of a jejunostomy feeding tube to patients expected to suffer from postoperative malnutrition or suffer from more advanced disease.…”

Complications of Feeding Jejunostomy Tubes in Patients with Gastroesophageal Cancer

“…Recently, two large registry studies for gastric cancer reported conflicting results whether concurrent placement of FJTs at the time of gastrectomy was associated with increased major surgical morbidity [5, 6]. Regardless of these notable conflicts, neither of these two studies specifically examined FJT-related complications.…”