Advertisement

Journal of Gastrointestinal Surgery

, Volume 17, Issue 8, pp 1352–1358 | Cite as

Pre-therapy Laparoscopic Feeding Jejunostomy is Safe and Effective in Patients Undergoing Minimally Invasive Esophagectomy for Cancer

  • Kfir Ben-DavidEmail author
  • Tad Kim
  • Angel M. Caban
  • Georgios Rossidis
  • Sara S. Rodriguez
  • Steven N. Hochwald
Original Article

Abstract

Objective

Laparoscopic feeding jejunostomy is a safe and effective means of providing enteral nutrition in the preoperative phase to esophageal cancer patients.

Design

This research is a retrospective case series.

Setting

This study was conducted in a university tertiary care center.

Patients

Between August 2007 and April 2012, 153 laparoscopic feeding jejunostomies were performed in patients 10 weeks prior to their definitive minimally invasive esophagectomy.

Main Outcome Measures

The outcome is measured based on the technique, safety, and feasibility of a laparoscopic feeding jejunostomy in the preoperative phase of esophageal cancer patients.

Results

One hundred fifty-three patients underwent a laparoscopic feeding jejunostomy approximately 1 and 10 week(s) prior to the start of their neoadjuvant therapy and definitive minimally invasive esophagectomy, respectively. Median age was 63 years. Of the patients, 75 % were males and 25 % were females. One hundred twenty-seven patients had gastroesophageal junction adenocarcinoma and 26 had squamous cell carcinoma. All patients completed their neoadjuvant chemoradiation therapy. The median operative time was 65 min. We had no intraoperative complications, perforation, postoperative bowel necrosis, bowel torsion, herniation, intraperitoneal leak, or mortality as a result of the laparoscopic feeding jejunostomy. Four patients were noted to have superficial skin infection around the tube, and 11 patients required a tube exchange for dislodgment, clogging, and leaking around the tube. All patients progressed to their definitive surgical esophageal resection.

Conclusion

A laparoscopic feeding jejunostomy is technically feasible, safe, and can provide appropriate enteral nutrition in the preoperative phase of esophageal cancer patients.

Keywords

Laparoscopic feeding jejunostomy Minimally invasive esophagectomy Esophageal cancer 

References

  1. 1.
    Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 1999;230:392–403.PubMedCrossRefGoogle Scholar
  2. 2.
    Kim T, Hochwald SN, Sarosi GA, Caban AM, Rossidis G, Ben-David K. Review of minimally invasive esophagectomy and current controversies. Gastroenterol Res Pract. 2012; 2012:683213.PubMedGoogle Scholar
  3. 3.
    Davies AR, Forshaw MJ, Khan AA, Noorani AS, Patel VM, Strauss DC, Mason RC. Transhiatal esophagectomy in a high volume institution. World J Surg Oncol 2008;6:88.PubMedCrossRefGoogle Scholar
  4. 4.
    Kight CE. Nutrition considerations in esophagectomy patients. Nutr Clin Pract 2008;23:521–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Ryan AM, Rowley SP, Healy LA, Flood PM, Ravi N, Reynolds JV. Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit. Clin Nutr 2006;25:386–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, Daley J, Henderson WG, Krasnicka B, Khuri SF. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 2003;75:217–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Kudsk KA, Tolley EA, DeWitt RC, Janu PG, Blackwell AP, Yeary S, King BK. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr 2003;27:1–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim T, Grobmyer SR, Smith RD, Ben-David K, Ang DN, Vogel SB, Hochwald SN. Esophageal cancer – the five year survivors. J Surg Oncol 2010;103:179–83.PubMedCrossRefGoogle Scholar
  9. 9.
    Gianotti L, Braga M, Nespoli L, Radaelli G, Beneduce A, Di Carlo V. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology 2002;122:1763–70.PubMedCrossRefGoogle Scholar
  10. 10.
    Alverdy J, Chi HS, Sheldon G. The effect of parenteral nutrition on gastrointestinal immunity: the importance of enteral stimulation. Ann Surg 1985;202:681–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Langkamp-Henken B, Glezer JA, Kudsk KA. Immunologic structure and function of the gastrointestinal tract. Nutr Clin Pract 1992;7:100–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 2008;12:739–55.PubMedCrossRefGoogle Scholar
  13. 13.
    Tapia J, Murguia R, Garcia G, de los Monteros PE, Oñate E. Jejunostomy: techniques, indications, and complications. World J Surg 1999;23:596–602.PubMedCrossRefGoogle Scholar
  14. 14.
    Fenton JR, Bergeron EJ, Coello M, Welsh RJ, Chmielewski GW. Feeding jejunostomy tubes placed during esophagectomy: are they necessary? Ann Thorac Surg 2011;92:504–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Llaguna OH, Kim HJ, Deal AM, Calvo BF, Stitzenberg KB, Meyers MO. Utilization and morbidity associated with placement of a feeding jejunostomy at the time of gastroesophageal resection. J Gastrointest Surg 2011;15:1663–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Gerndt SJ, Orringer MB. Tube jejunostomy as an adjunct to esophagectomy. Surgery 1994;115:164–9.PubMedGoogle Scholar
  17. 17.
    Brock MV, Venbrux AC, Heitmiller RF. Percutaneous replacement jejunostomy after esophagogastrectomy. J Gastrointest Surg 2000;4:407–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Finley FJ, Lamy A, Clifton J, Evans KG, Fradet G, Nelems B. Gastrointestinal function following esophagectomy for malignancy. Am J Surg 1995;169:471–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Date RS, Clements WD, Gilliland R. Feeding jejunostomy: is there enough evidence to justify its routine use? Dig Surg 2004;21:142–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Myers JG, Page CP, Stewart RM, Schwesinger WH, Sirinek KR, Aust JB. Complications of needle catheter jejunostomy in 2,022 consecutive applications. Am J Surg 1995;170:547–51.PubMedCrossRefGoogle Scholar
  21. 21.
    Haun JL, Thompson JS. Comparison of needle catheter versus standard tube jejunostomy. Am Surg 1985;51:466–9.PubMedGoogle Scholar
  22. 22.
    Allen JW, Ali A, Wo J, Bumpous JM, Cacchione RN. Totally laparoscopic feeding jejunostomy. Surg Endosc 2002;16:1802–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Han-Geurts IJ, Verhoef C, Tilanus HW. Relaparotomy following complications of feeding jejunostomy in esophageal surgery. Dig Surg 2004;21:192–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Han-Geurts IJ, Hop WC, Verhoef C, Tran KT, Tilanus HW. Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. Br J Surg 2007;94:31–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Ben-David K, Sarosi GA, Cendan JC, Howard D, Rossidis G, Hochwald SN. Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies. Surg Endosc 2012;26:162–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Ben-David K, Rossidis G, Zlotecki RA, Grobmyer SR, Cendan JC, Sarosi GA, Hochwald SN. Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiation therapy. Ann Surg Oncol 2011;18:3324–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Markides GA, Al-Khaffaf B, Vicker J. Nutritional access routes following oesophagectomy – a systematic review. Eur J Clin Nutr 2011;65:565–73.PubMedCrossRefGoogle Scholar
  28. 28.
    Mistry RC, Mehta SS, Karimundackal G, Pramesh CS. Novel cost-effective method of laparoscopic feeding-jejunostomy. J Minim Access Surg 2009;5:43–6.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Kfir Ben-David
    • 1
    Email author
  • Tad Kim
    • 1
  • Angel M. Caban
    • 1
  • Georgios Rossidis
    • 1
  • Sara S. Rodriguez
    • 1
  • Steven N. Hochwald
    • 1
  1. 1.Department of Surgery, College of MedicineUniversity of FloridaGainesvilleUSA

Personalised recommendations