Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage

Abstract

Background: Feeding jejunostomy is widely used for enteral nutrition (EN) after esophagectomy; however, its risks and benefits are still controversial. We aimed to evaluate the short-term and long-term outcomes of feeding jejunal tube (FJT) in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) who were deemed high-risk for anastomotic leakage.Methods: We retrospectively analyzed 716 patients who underwent esophagectomy with (FJT group, n=68) or without (control group, n=648) intraoperative placement of FJT. Propensity score matching (PSM) was used for the adjustment of confounding factors. Risk level for anastomotic leakage was determined for every patient after PSM.Results: Patients in the FJT group were at higher risk of anastomotic leakage (14.9% vs. 11.3%), and had a statistically non-significant increase of postoperative complications [31.3% vs. 21.8%, odds ratio (OR) =1.139, 95% confidence interval (CI), 0.947-1.370, P=0.141] after PSM. Medical expenditure, length of postoperative hospital stay, and short-term mortality were similar between the FJT and control groups. Placement of FJT appeared to accelerate the recovery of anastomotic leakage (27.2 vs. 37.4 d, P=0.073). Patients in FJT group achieved comparable overall survival (OS) both before [hazard ratio (HR) =0.850, P=0.390] and after (HR =0.797, P=0.292) PSM.Conclusions: FJT showed acceptable safety profile along with potential benefits for ESCC patients with a high presumed risk of anastomotic leakage. While FJT does not impact OS, placement of FJT should be considered in esophagectomy patients and tailored to individual patients based on their leak-risk profile.

Consequences of anastomotic leaks after minimally invasive esophagectomy: A single-center experience

“…Patients with AL were also more likely to maintain dependence on tube feeds for adequate nutrition, resulting in the longer time to discontinuation of the jejunostomy tube in the AL cohort (134 days vs 79 days). While the presence of a jejunostomy tube had no effect on overall survival following AL in the literature, its use was associated with an expedited recovery and allowed for home enteral nutrition, supporting its prolonged use in our cohort [ 44 , 45 ]. Our study also found an increased number of endoscopic balloon dilations in the first postoperative year following an AL (1.40 vs 0.46).…”

A Study on Risk Factors Associated with Reflux Esophagitis in Patients Undergoing Esophageal Cancer Surgery

“…At present, the effects of the gastric tube and whole stomach reconstruction on the postoperative complications have been confirmed. Most studies have concluded that the gastric tube with narrow top and wide bottom is closer to the physiological structure of the esophagus and can minimize the changes of the thoracic cavity, so adopting the gastric tube can reduce the incidence of postoperative complications and improve the patients' quality of life [ 20 , 21 ]. There is no final conclusion on whether the gastric tube can reduce the incidence of reflux esophagitis.…”

Postoperative Nutrition Management: Who Needs What?

“…The FNCJ group tended to have faster healing of an anastomotic leakage (27.2 days vs. 37.4 days; p = 0.073). The results showed that FNCJ is safe and is particularly suitable for high-risk patients [35]. A metaanalysis of 10 studies comparing jejunostomy with nasojejunal tubes after esophagectomy showed significant advantages in favor of jejunostomy in terms of postoperative pneumonia, length of hospital stay, and risk of dislocation [36].…”

“…Retrospectively, Zhuang et al [35] analyzed the outcomes of their patients after esophagectomy with and without intraoperative FNCJ. The feeding tube was implanted only in those patients considered at a high-risk of anastomotic leakage.…”