Weitao Zhuang1,2, Hansheng Wu1,3, Huiling Liu1, Shujie Huang1,2, Yinghong Wu1, Cheng Deng1, Dan Tian1, Zihao Zhou1, Ruiqing Shi1, Gang Chen1, Guillaume Piessen4, Puja G Khaitan5, Kazuo Koyanagi6, Soji Ozawa6, Guibin Qiao1. 1. Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. 2. Shantou University Medical College, Shantou, China. 3. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China. 4. University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France. 5. Division of Thoracic and Esophageal Surgery, Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA. 6. Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
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. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
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. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
Entities:
Keywords:
Esophageal cancer (ESCA); anastomotic leakage; esophagectomy; feeding jejunostomy
Authors: X B D'Journo; M Ouattara; A Loundou; D Trousse; L Dahan; T Nathalie; C Doddoli; J F Seitz; P-A Thomas Journal: Dis Esophagus Date: 2011-11-28 Impact factor: 3.429
Authors: Richard Zheng; Courtney L Devin; Michael J Pucci; Adam C Berger; Ernest L Rosato; Francesco Palazzo Journal: World J Gastroenterol Date: 2019-08-21 Impact factor: 5.742