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Cessation of Routine Jejunostomy Tube Placement at Time of Minimally Invasive Ivor Lewis Esophagectomy and Impact on Body Mass Index

Published:October 11, 2022DOI:https://doi.org/10.1053/j.semtcvs.2022.09.007
      Jejunostomy tubes are frequently placed at time of esophagectomy. The purpose of this study is to evaluate cessation of routine j-tube placement on postoperative body mass index (BMI), return to the emergency room, and time until adjuvant therapy. We performed a retrospective review of an institutional database for consecutive patients undergoing minimally invasive Ivor Lewis Esophagectomy from 2014-2021 (after January 2019, routine j-tube placement was abandoned). Data was analyzed using Pearson′s Chi-squared tests and Student's t test with 2-sided significance level of P < 0.05. In total,179 patients were included, 95 underwent j-tube placement and 84 did not. Cohorts had comparable baseline BMI's (no j-tube: 30.48 vs j-tube: 28.64, P = 0.06) and anastomotic leak rates (2.4% vs 4.2%, P = 0.5). Patients with no jejunostomy tubes were more likely to receive total parenteral nutrition (14.3% vs 5.3%, P < 0.05), but were no more likely to require total parenteral nutrition at discharge and had comparable durations of TPN requirement (7 days vs 12 days, P = 0.53). There was no difference in mean BMI reduction at 2 weeks (2.54 vs 2.09, P = 0.49) and 3-6 months postoperatively (6.11 vs 4.45 P = 0.15). There was no difference in return to the emergency room (8.3% vs 8.4%, P = 0.98) or readmissions (13.1% vs 11.6%, P = 0.76). There was a no difference in mean time to adjuvant therapy (83.5 days vs 72.6 days, P = 0.67). At esophagectomy centers with low anastomotic leak rates, cessation of routine j-tube placement at time of minimally esophagectomy can be undertaken without increasing risk of readmission, time until initiation of adjuvant therapy, or significantly impacting postoperative BMI loss.

      Graphical Abstract

      Keywords

      Abbreviations:

      J-tube (jejunostomy tube), BMI (body mass index), ER (emergency room), ECCG (esophageal complication consensus group), EGD (esophagogastroduodenoscopy), NGT (nasogastric tube), ERAS (enhanced recovery after surgery), POD (postoperative day), NPO (nil per os (nothing by mouth)), TPN (total parenteral nutrition)
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      References

        • Finks J.F.
        • Osborne N.H.
        • Birkmeyer J.D.
        Trends in hospital volume and operative mortality for high-risk surgery.
        N Engl J Med. 2011; 364: 2128-2137
        • Low D.E.
        • Kuppusamy M.K.
        • Alderson D.
        • et al.
        Benchmarking complications associated with esophagectomy.
        Ann Surg. 2019; 269: 291-298
        • Martin J.T.
        • Federico J.A.
        • McKelvey A.A.
        • et al.
        Prevention of delayed gastric emptying after esophagectomy: A single center's experience with botulinum toxin.
        Ann Thorac Surg. 2009; 87 (discussion 1713-1704): 1708-1713
        • (NCCN) NCCN
        Esophageal and esophagogastric junction cancers, Version 2.2019, NCCN clinical practice guidelines in oncology.
        JNCCN. 2019; : 17
        • Carroll P.A.
        • Yeung J.C.
        • Darling G.E.
        Elimination of routine feeding jejunostomy after esophagectomy.
        Ann Thorac Surg. 2020; 110: 1706-1713
        • Kroese T.E.
        • Tapias L.
        • Olive J.K.
        • et al.
        Routine intraoperative jejunostomy placement and minimally invasive oesophagectomy: An unnecessary step?dagger.
        Eur J Cardiothorac Surg. 2019; 56: 746-753
        • Baker A.
        • Wooten L.A.
        • Malloy M.
        Nutritional considerations after gastrectomy and esophagectomy for malignancy.
        Curr Treat Options Oncol. 2011; 12: 85-95
        • Peng J.
        • Cai J.
        • Niu Z.X.
        • et al.
        Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: A meta-analysis.
        Dis Esophagus. 2016; 29: 333-341
        • Zheng R.
        • Devin C.L.
        • Pucci M.J.
        • et al.
        Optimal timing and route of nutritional support after esophagectomy: A review of the literature.
        World J Gastroenterol. 2019; 25: 4427-4436
        • Hynes O.
        • Anandavadivelan P.
        • Gossage J.
        • et al.
        The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer.
        Eur J Surg Oncol. 2017; 43: 1559-1565
        • Weijs T.J.
        • Berkelmans G.H.
        • Nieuwenhuijzen G.A.
        • et al.
        Routes for early enteral nutrition after esophagectomy. A systematic review.
        Clin Nutr. 2015; 34: 1-6
        • Eberhard K.E.
        • Achiam M.P.
        • Rolff H.C.
        • et al.
        Comparison of “Nil by Mouth” versus early oral intake in three different diet regimens following esophagectomy.
        World J Surg. 2017; 41: 1575-1583
        • Bolton J.S.
        • Conway W.C.
        • Abbas A.E.
        Planned delay of oral intake after esophagectomy reduces the cervical anastomotic leak rate and hospital length of stay.
        J Gastrointest Surg. 2014; 18: 304-309
        • Tomaszek S.
        • Cassivi S.D.
        Esophagectomy for the treatment of esophageal cancer.
        Gastroenterol Clin North Am. 2009; 38 (x): 169-181
        • Low D.E.
        • Alderson D.
        • Cecconello I.
        • et al.
        International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy: Esophagectomy Complications Consensus Group (ECCG).
        Ann Surg. 2015; 262: 286-294
        • Weijs T.J.
        • van Eden H.W.J.
        • Ruurda J.P.
        • et al.
        Routine jejunostomy tube feeding following esophagectomy.
        J Thorac Dis. 2017; 9: S851-S860