Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy

Janssen, Henricus J. B.; Gantxegi, Amaia; Fransen, Laura F C; Nieuwenhuijzen, Grard A. P.; Luyer, Misha

doi:10.3390/nu13103616

Cited by 3 publications

(3 citation statements)

References 50 publications

(91 reference statements)

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“…Endoscopic pyloromyotomy was proposed as an alterantive for pyloric drainage [18]. Feeding jejunostomy is used routinely in our department to facilitate enteral nutrition in the postoperative period [19].…”

Section: Discussionmentioning

confidence: 99%

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Achim

Constantin

Mossen

et al. 2022

Preprint

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Introduction: Minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer over the past three decades. By introducing minimally invasive techniques, esophageal oncological surgery has advanced in terms of safety, radicality, functional preservation and quality of life post-esophagectomy of the patients. Material and Method: We present the experience of the Center of Excellence in Esophageal Surgery at Sf. Maria Clinical Hospital regarding total (MIE) through total 3D HD thoraco-laparoscopic modified McKeown triple approach. In between January 2015 - December 2021, 24 patients (M) were treated for thoracic esophageal cancer. The average age of patients was 57 years. Most of the esophageal tumors were midthoracic (62.5%), 83.3% were squamous carcinomas and half were moderately differentiated. Most of the esophageal tumors were locally advanced tumors (cT3N1 – 58.3%), 18 patients were staged III. 70.8% of patients received neoadjuvant chemo radiotherapy. Results: Thoracoscopic esophageal mobilizations were successful in all 24 patients, no conversion to thoracotomy. Laparoscopic gastric mobilizations were successful in all 24 patients, conversion to open technique was performed in 7 patients for creation extracoporeally of the gastric conduit through an epigastric minilaparotomy. The esophageal substitute was represented by the gastric conduit. The intraoperative blood loss was minimal. The average duration of surgical interventions was 360 minutes. All the surgical interventions were considered with curative intention (R0). The rate of intraoperative complications was 20.8%. The rate of early postoperative complications was 66%. Distribution of postoperative complications according to the Clavien-Dindo Classification (0-33.3%, 1-16.6%, 2-4.1%, 3a-12.5%, 3b-8.3%, 4a-0%, 4b-8.3%, 5-16.6%) highlighted a rate of 33.3% of major complications. The advantages of MIE observed in the studied group in the postoperative period were: reduced postoperative pain, improved comfort and early mobilization of the patients. Conclusions: The early outcomes of using the minimally invasive approach in the treatment of esophageal cancer in our clinic include the reduction of perioperative morbidity, the duration of hospitalization and a faster recovery.

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Section: Discussionmentioning

confidence: 99%

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Achim

Constantin

Mossen

et al. 2022

Preprint

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“…Although naso-jejunal tubes, like FJs and TPN, ensure a nil-per-mouth policy, they cause great discomfort to patients [ 6 , 12 ]. Proponents of DOF believe DOF leads to fewer complications and faster time to functional recovery, while opponents express the fear of a slower recovery and higher anastomotic leakage rates [ 5 , 19 , 20 ]. In the Netherlands, hospitals do appear to prefer the routine placement of FJs.…”

Section: Discussionmentioning

confidence: 99%

“…Patients on only DOF after MIE have been reported to require the start of nonoral nutrition in 38% of cases, mainly due to complications (36%) [ 25 ]. Another recent study identified female sex and higher ASA scores as independent risk factors for requiring an FJ to ensure nutrition [ 19 ]. In 29.7% of patients, an FJ was needed due to complications or the failure to meet nutritional goals.…”

Section: Discussionmentioning

confidence: 99%

Hospital Variation in Feeding Jejunostomy Policy for Minimally Invasive Esophagectomy: A Nationwide Cohort Study

et al. 2022

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The purpose of this study was to investigate hospital variation in the placement, surgical techniques, and safety of feeding jejunostomies (FJ) during minimally invasive esophagectomy (MIE) in the Netherlands. This nationwide cohort study analyzed patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) that underwent MIE for cancer. Hospital variation in FJ placement rates were investigated using case-mix corrected funnel plots. Short-term outcomes were compared between patients with and without FJ using multilevel multivariable logistic regression analysis. The incidence of FJ-related complications was described and compared between hospitals performing routine and non-routine placement (≥90%–<90% of patients). Between 2018–2020, an FJ was placed in 1481/1811 (81.8%) patients. Rates ranged from 11–100% among hospitals. More patients were discharged within 10 days (median hospital stay) without FJ compared to patients with FJ (64.5% vs. 50.4%; OR: 0.62, 95% CI: 0.42–0.90). FJ-related complications occurred in 45 (3%) patients, of whom 23 (1.6%) experienced severe complications (≥Clavien–Dindo IIIa). The FJ-related complication rate was 13.7% in hospitals not routinely placing FJs vs. 1.7% in hospitals performing routine FJ placement (p < 0.001). Significant hospital variation in the use of FJs after MIE exists in the Netherlands. No effect of FJs on complications was observed. FJs can be placed safely, with lower FJ-related complication rates, in centers performing routine placement.

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Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma

Xu¹,

Lin²,

Chen³

et al. 2022

Ann Transl Med

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Background: The textbook outcome (TO) emerges as a novel prognostic factor in surgical oncology.The present study aimed to evaluate the effect of TO on the risk of death and recurrence in patients with esophageal squamous cell carcinoma (ESCC) after minimally invasive esophagectomy (MIE). Methods:The study involved retrospective analysis of 528 patients with ESCC who were subjected to MIE from January 2011 to December 2017. TO included 8 parameters: complete resection; microscopically tumor-negative resection margins (R0); ≥15 lymph nodes removed and examined; no serious postoperative complications; no postoperative intervention; no re-admission to the intensive care unit (ICU); hospital stay ≤21 days; and no readmission ≤30 days. The Cox and logistic regression model were used to analyze the prognostic factors of survival and risk factors for TO.Results: Among the 528 patients with ESCC who were subjected to MIE, 53.2% reached TO. In the case of patients with locally advanced ESCC, 5-year overall survival (OS) was 51.1% (41.2-61.2%) for the TO group but 33.7% (23.7-43.7%) for the non-TO group (HR =0.644, 95% CI: 0.449-0.924, P=0.015).Similarly, 5-year disease-free survival (DFS) was 47.6% (38.0-57.2%) for the TO group but 29.1% (20.1-38.1%) for the non-TO group (HR =0.671, 95% CI: 0.479-0.940, P=0.018). In addition, 5-year recurrencefree survival (RFS) was 62.9% (53.7-72.1%) for the TO group but 39.8% (29.4-50.2%) for the non-TO group (HR =0.606, 95% CI: 0.407-0.902, P=0.012). Multivariate logistic regression analysis further showed that age, American Society of Anesthesiology (ASA) score, intraoperative blood loss, and smoking status acted as independent risk factors for TO. The results of the multivariate analysis assisted in the establishment of a nomogram for the prediction of TO occurrence. This nomogram exhibited satisfactory consistency and prediction ability [area under the receiving operator characteristic (AUROC) =0.717].

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Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy

Cited by 3 publications

References 50 publications

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Hospital Variation in Feeding Jejunostomy Policy for Minimally Invasive Esophagectomy: A Nationwide Cohort Study

Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma

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