Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma

Abstract

Aims: Bedside electromagnetic (EM) guided nasojejunal feeding tube placement by nurses is a simple and safe technique which has replaced endoscopy in several patient categories. An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contra-indication for this technique. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared to endoscopy in patients after pancreatoduodenectomy. Methods: We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012eMarch 2014). Nasojejunal tubes were placed under EM-guidance by two nurses with extensive experience with the technique, or by endoscopy when neither of the two nurses was available. Primary endpoint was the success rate of primary tube placement confirmed on plain abdominal X-ray followed by successful enteral feeding. Results: Overall, 53 of 126 (42%) patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube. In 36 patients the tube was placed under EM-guidance and in 17 by endoscopy at a median of 8 (6e11) days after pancreatoduodenectomy. Initial tube placement was successful in 21 of 36 (58%) patients with EM-guidance and 9 of 17 (53%) patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 of 36 (39%) patients in the EM-guided group and 8 of 17 (47%) patients in the endoscopic group (P = 0.57). Conclusions: Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy. Future, randomized studies should confirm these preliminary findings.

Tumour brain: Pretreatment cognitive and affective disorders caused by peripheral cancers

“…The existence of pretreatment cognitive and affective disorders in people with non‐CNS cancers indicates a bidirectional crosstalk between the TME and CNS, which is likely to occur indirectly, via modulation of the innate immune system, and/or directly, through neurotransmitter release (Monje et al, 2020; Olson & Marks, 2019). However, even though cancer‐associated neurological disturbances have been reported in a variety of pretreatment peripheral cancers, the mechanisms underlying these phenomena are still unknown (Baekelandt et al, 2016; Berman et al, 2014). A better understanding of how extracranial tumour growth leads to neurological complications is critical to enhancing patient survival.…”