Nasojejunal Tube Placement After Total Gastrectomy

Abstract

Hypothesis: Anastomotic disruption of the Roux-en-Y esophagojejunostomy after total gastrectomy is an infrequent complication that may lead to severe morbidity and mortality. Consequently, a nasojejunal tube (NJT) is frequently placed when this operation is performed. However, no studies have compared routine vs no placement of an NJT in patients undergoing total gastrectomy for gastric cancer, to our knowledge. Design: Randomized controlled trial to assess the need for routine nasojejunal decompression after total gastrectomy with Roux-en-Y esophagojejunostomy in patients with gastric cancer. Setting: Tertiary care centers. Patients: Two hundred thirty-seven patients undergoing total gastrectomy for gastric cancer were randomly assigned to NJT placement (NJT group) or not (no-NJT group). The patients were monitored for postoperative complications, mortality, and postoperative course. Main Outcome Measures: Incidence of esophagojejunostomy leak. Results: The rates of anastomotic leak were similar in both groups (6.9% and 5.8% for the NJT group and no-NJT group, respectively; P = .71), as were the rates of major postoperative complications (25.9% and 21.5%, respectively; P = .42) and overall postoperative mortality (0.9% and 0.8%, respectively; P=.50). There were no differences between the 2 groups in the mean±SD time to passage of flatus (4.6 ± 1.3 and 4.5 ± 1.7 days, respectively) or to starting a liquid diet (7.8 ± 2.6 and 7.7 ± 1.6 days, respectively), postoperative length of hospital stay (13.5 ± 7.3 and 13.9 ± 10.9 days, respectively), postoperative pain, or postoperative abdominal distention. Conclusion: Routine placement of an NJT after Rouxen-Y esophagojejunostomy is unnecessary in elective total gastrectomy for gastric cancer.

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

“…Not surprisingly, and consistent with published data, surgical site infection and sepsis are the two most common metrics of NSQIP measured morbidity in this study (16). The organ space SSI of 7.05% is consistent with published rates of anastomotic leaks in recent literature ranging from 5 to 7%, however without targeted NSQIP data collection, the exact proportion of anastomotic leaks rather than other surgically-related causes of intra-abdominal infection cannot be defined precisely (17–20). …”

Nasogastric Decompression for Radical Gastrectomy for Gastric Cancer: A Prospective Randomized Controlled Study

“…Nasogastric intubation has been thought to reduce postoperative respiratory complications and the incidence of anastomotic leaks after gastrointestinal surgery. However, the necessity of nasogastric decompression following radical gastrectomy has been increasingly queried over the last decade [10,11,12,13,14]. …”

Nutritional Support and Oral Intake after Gastric Resection in Five Northern European Countries

“…However, their trial neither aimed to address this issue, nor was it adequately powered to allow for any definitive conclusions. A recent prospective, randomised and adequately powered trial has shown the NJ tube to be unnecessary in elective total gastrectomies [15]. While the lack of uniformity remains the main finding in the present study, there was a tendency in Norway and Sweden to remove the tubes more liberally.…”