Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition

Koterazawa, Yasufumi; Oshikiri, Taro; Hasegawa, Hiroshi; Yamamoto, Masashi; Kanaji, Shingo; Yamashita, Kimihiro; Matsuda, Takeru; Suzuki, Satoshi; Kakeji, Yoshihiro

doi:10.1093/dote/doz021

Cited by 29 publications

(31 citation statements)

References 29 publications

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“…The observed higher incidence of pneumonia in the jejunostomy group is, to our knowledge, not previously [20,21]. Although it might reflect the association between jejunostomy and small bowel obstruction, as has been suggested by Koterazawa et al [22], this was not seen in our study. Among surgical complications, the only statistically significant finding was an increased frequency of recurrent laryngeal nerve paralysis in the jejunostomy group.…”

Section: Discussioncontrasting

confidence: 59%

Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival

Holmén

Hayami

Szabó

et al. 2020

Langenbecks Arch Surg

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Purpose Insertion of a nutritional jejunostomy in conjunction with esophagectomy is performed with the intention to decrease the risk for postoperative malnutrition and improve recovery without adding significant catheter-related complications. However, previous research has shown no clear benefit and there is currently no consensus of practice. Methods All patients treated with esophagectomy due to cancer during the period 2006–2017 reported in the Swedish National Register for Esophageal and Gastric Cancer were included in this register-based cohort study from a national database. Patients were stratified into two groups: esophagectomy alone and esophagectomy with jejunostomy. Results A total of 847 patients (45.27%) had no jejunostomy inserted while 1024 patients (54.73%) were treated with jejunostomy. The groups were comparable, but some differences were seen in histological tumor type and tumor stage between the groups. No significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate were seen. There was no evidence of increased risk for significant jejunostomy-related complications. Patients in the jejunostomy group with anastomotic leaks had a statistically significant lower risk for severe morbidity defined as Clavien-Dindo score ≥ IIIb (adjusted odds ratio 0.19, 95% CI: 0.04–0.94, P = 0.041) compared to patients with anastomotic leaks and no jejunostomy. Conclusion A nutritional jejunostomy is a safe method for early postoperative enteral nutrition which might decrease the risk for severe outcomes in patients with anastomotic leaks. Nutritional jejunostomy should be considered for patients undergoing curative intended surgery for esophageal and gastro-esophageal junction cancer.

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Section: Discussioncontrasting

confidence: 59%

Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival

Holmén

Hayami

Szabó

et al. 2020

Langenbecks Arch Surg

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“…The studies conducted by Álvarez-Sarrado et al (4) and Akiyama et al (5) demonstrated that the total protein and albumin levels were similar between the FTJ-G and no FTJ-G on postoperative day 7. The changes in body weight or BMI 1, 3, and 6 months after surgery were also comparable between the FJT-G and no FJT-G (5,6,13). These results indicated that the postoperative nutrition status of patients in the FJT-G and no FJT-G was similar.…”

Section: Discussionmentioning

confidence: 53%

“…Recent studies have questioned the need for a FJT in all esophageal cancer patients (4)(5)(6). Because most patients resume oral intake shortly after surgery, providing nutrition via a FJT is not critical.…”

Section: Introductionmentioning

confidence: 99%

Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—a systematic review and meta-analysis

Xu¹,

Zhuo²,

et al. 2021

Ann Palliat Med

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Background: Malnutrition dramatically increases the risk of postoperative complications and delays patient recovery. Therefore, a feeding jejunostomy tube (FJT) is routinely placed during esophagectomy to maintain the postoperative nutrition supply. However, recently published studies have questioned the need of a FJT in every esophageal cancer patient. Because most patients can resume oral intake shortly after surgery, the nutrition-providing function of a FJT becomes much less critical. In contrast, FJT-related complications could be severe.Methods: Relevant publications were found out by systemic searching of four medical databases (Pubmed, EMBASE, Medline, and Cochrane Center Register of Controlled Trials). By reading the titles and the abstracts, potentially relevant studies were screened from the search results. The incidence of postoperative complications and FJT-related complications were calculated and compared to evaluate the efficacy of a FJT.Results: Eighteen studies were included in the meta-analysis. The no-FJT group had a similar or even lower incidence of postoperative complications [anastomotic leakage (AL), pulmonary complications, and wound infections] compared with the FJT group. Ileus and FJT site infections were the most common FJTrelated complications. The incidence of ileus was approximately 6% (95% CI: 3-12%), and over 63% of the patients with an ileus required re-operation to relieve the obstruction. The pooled mean rate of FJT site infections was 7% (95% CI: 6-9%). Approximately 7% of patients had dysfunction (obstruction or dislocation) of the jejunostomy tube (95% CI: 3-14%). Conclusions:The non-selective placement of a FJT during esophagectomy provides few benefits to the patients and may even increase the risk of postoperative complications. Therefore, an intraoperative FJT should be selectively prescribed, but not routinely in the surgical treatment of esophageal cancer.

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“…18 In a previous study of HALS, button-typed jejunostomy for enteral nutrition was considered the cause of small bowel obstruction, but the incidence of small bowel obstruction decreased after the jejunostomy method was changed. 19 There were no significant differences in the occurrence of anastomotic complications between the HALS and LAP groups. Both procedures enabled the construction of a carefully designed gastric conduit in which blood flow could be assessed with thermal imaging.…”

Section: Discussionmentioning

confidence: 77%

“…This may be attributable to the increased micro‐damage inflicted by the forceps in LAP 18 . In a previous study of HALS, button‐typed jejunostomy for enteral nutrition was considered the cause of small bowel obstruction, but the incidence of small bowel obstruction decreased after the jejunostomy method was changed 19 …”

Section: Discussionmentioning

confidence: 99%

Comparison of laparoscopic surgery and hand‐assisted laparoscopic surgery in esophagectomy: A propensity score‐matched analysis

Tanishima

Nishikawa

Matsumoto

et al. 2020

Asian J Endoscop Surgery

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Introduction: Laparoscopic surgery (LAP) and hand-assisted laparoscopic surgery (HALS) for mobilization of the stomach and abdominal lymph node dissection in esophagectomy have become standard procedures in Japan. However, the differences in outcomes between LAP and HALS have not been examined. We aimed to compare the safety and feasibility of these techniques in patients undergoing esophagectomy. Methods: We assessed 171 patients who underwent esophagectomy and reconstruction for clinical stage 0 to IVa esophageal cancer; 108 patients were treated with HALS and 63 with LAP. Mortality, morbidity, and long-term survival were compared in all patients who had undergone these surgical procedures and then in 59 propensity score-matched pairs to correct for differences in baseline characteristics. Results: In our analysis, HALS had a shorter abdominal operative time (84.4 ± 26.6 vs 110.0 ± 34.1 minutes, P < .0001), but LAP enabled a larger number of abdominal lymph nodes to be harvested with (17.9 ± 6.6 vs 15.4 ± 7.4, P = .0486). The 5-year overall survival rates were 62.1% and 74.5% (P = .1257) for patients who had undergone HALS and LAP, respectively, and the relapse-free survival rates were 67.0% and 72.3% (P = .7243). Conclusions: There were no significant differences in postoperative mortality and morbidity between the two groups. This suggests that in addition to having a short operative time, HALS has good technical feasibility and is oncologically safe for patients with esophageal cancer.

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Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition

Cited by 29 publications

References 29 publications

Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival

Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival

Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—a systematic review and meta-analysis

Comparison of laparoscopic surgery and hand‐assisted laparoscopic surgery in esophagectomy: A propensity score‐matched analysis

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