Catherine H Davis1, Naruhiko Ikoma2, Paul F Mansfield2, Prajnan Das3, Bruce D Minsky3, Mariela A Blum4, Jaffer A Ajani4, Barbara L Bass1, Brian D Badgwell5. 1. Department of Surgery, Houston Methodist Hospital, Houston, TX, USA. 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX, 77030, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX, 77030, USA. bbadgwell@mdanderson.org.
Abstract
BACKGROUND: Optimal nutrition is challenging for patients with gastric and gastroesophageal adenocarcinoma and often requires feeding tube placement prior to preoperative therapy. Feeding jejunostomy (FJ) placement via mini-laparotomy is technically easier to perform than laparoscopic FJ. The purpose of this study was to compare outcomes in patients with gastric adenocarcinoma undergoing laparoscopic versus mini-laparotomy FJ placement. METHODS: A retrospective cohort study was performed of patients with gastric adenocarcinoma receiving laparoscopic versus mini-laparotomy FJ at a single tertiary referral center from 2000 to 2018. 30-day outcomes included complications, conversion to laparotomy, reoperation, length of stay, and readmission. RESULTS: A total of 656 patients met the inclusion criteria and were studied. The majority of patients were male (68.1%) with a mean age of 60.6 years. The difference in surgical approach remained relatively stable over time. Overall, 82 (12.5%) patients experienced complications, and three (0.5%) patients died postoperatively. While readmission and conversion to open laparotomy did not differ between groups, overall complications (10.5% vs. 20.8%, p = 0.002), Clavien-Dindo ≥ 3 complications (4.0% vs. 8.9%, p = 0.021), length of stay (4.1 vs. 5.6 days, p < 0.001), and reoperation (0.9% vs. 4.0%, p = 0.002) favored the laparoscopic over mini-laparotomy group. CONCLUSION: The current study helps clarify the risk of FJ placement in patients with gastric adenocarcinoma requiring nutritional support. Laparoscopic FJ placement has lower overall morbidity and length of stay compared to mini-laparotomy. However, caution is needed in preventing and identifying the rare causes of postoperative mortality that may be associated with laparoscopic FJ placement.
BACKGROUND: Optimal nutrition is challenging for patients with gastric and gastroesophageal adenocarcinoma and often requires feeding tube placement prior to preoperative therapy. Feeding jejunostomy (FJ) placement via mini-laparotomy is technically easier to perform than laparoscopic FJ. The purpose of this study was to compare outcomes in patients with gastric adenocarcinoma undergoing laparoscopic versus mini-laparotomy FJ placement. METHODS: A retrospective cohort study was performed of patients with gastric adenocarcinoma receiving laparoscopic versus mini-laparotomy FJ at a single tertiary referral center from 2000 to 2018. 30-day outcomes included complications, conversion to laparotomy, reoperation, length of stay, and readmission. RESULTS: A total of 656 patients met the inclusion criteria and were studied. The majority of patients were male (68.1%) with a mean age of 60.6 years. The difference in surgical approach remained relatively stable over time. Overall, 82 (12.5%) patients experienced complications, and three (0.5%) patients died postoperatively. While readmission and conversion to open laparotomy did not differ between groups, overall complications (10.5% vs. 20.8%, p = 0.002), Clavien-Dindo ≥ 3 complications (4.0% vs. 8.9%, p = 0.021), length of stay (4.1 vs. 5.6 days, p < 0.001), and reoperation (0.9% vs. 4.0%, p = 0.002) favored the laparoscopic over mini-laparotomy group. CONCLUSION: The current study helps clarify the risk of FJ placement in patients with gastric adenocarcinoma requiring nutritional support. Laparoscopic FJ placement has lower overall morbidity and length of stay compared to mini-laparotomy. However, caution is needed in preventing and identifying the rare causes of postoperative mortality that may be associated with laparoscopic FJ placement.
Authors: Teus J Weijs; Gijs H K Berkelmans; Grard A P Nieuwenhuijzen; Jelle P Ruurda; Richard van Hillegersberg; Peter B Soeters; Misha D P Luyer Journal: Clin Nutr Date: 2014-08-01 Impact factor: 7.324
Authors: Naruhiko Ikoma; Mariela Blum; Yi-Ju Chiang; Jeannelyn S Estrella; Sinchita Roy-Chowdhuri; Keith Fournier; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: Ann Surg Oncol Date: 2016-07-06 Impact factor: 5.344
Authors: Gregory C Dann; Malcolm H Squires; Lauren M Postlewait; David A Kooby; George A Poultsides; Sharon M Weber; Mark Bloomston; Ryan C Fields; Timothy M Pawlik; Konstantinos I Votanopoulos; Carl R Schmidt; Aslam Ejaz; Alexandra W Acher; David J Worhunsky; Neil Saunders; Edward A Levine; Linda X Jin; Clifford S Cho; Emily R Winslow; Maria C Russell; Kenneth Cardona; Charles A Staley; Shishir K Maithel Journal: J Surg Oncol Date: 2015-08-04 Impact factor: 3.454
Authors: Zhifei Sun; Mithun M Shenoi; Daniel P Nussbaum; Jeffrey E Keenan; Brian C Gulack; Douglas S Tyler; Paul J Speicher; Dan G Blazer Journal: J Surg Res Date: 2015-07-16 Impact factor: 2.192
Authors: Arja Gerritsen; Marc G Besselink; Kasia P Cieslak; Menno R Vriens; Elles Steenhagen; Richard van Hillegersberg; Inne H Borel Rinkes; I Quintus Molenaar Journal: J Gastrointest Surg Date: 2012-04-20 Impact factor: 3.452