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Comparison of laparoscopy versus mini-laparotomy for jejunostomy placement in patients with gastric adenocarcinoma

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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.

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Funding

This study was supported by the Holy Clegg Gastric Cancer Research Fund and the No Stomach for Cancer Award for Gastric Cancer Research.

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Authors and Affiliations

  1. Department of Surgery, Houston Methodist Hospital, Houston, TX, USA

    Catherine H. Davis & Barbara L. Bass

  2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX, 77030, USA

    Naruhiko Ikoma, Paul F. Mansfield & Brian D. Badgwell

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das & Bruce D. Minsky

  4. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela A. Blum & Jaffer A. Ajani

Authors
  1. Catherine H. Davis
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  2. Naruhiko Ikoma
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  3. Paul F. Mansfield
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  4. Prajnan Das
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  5. Bruce D. Minsky
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  6. Mariela A. Blum
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  7. Jaffer A. Ajani
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  8. Barbara L. Bass
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  9. Brian D. Badgwell
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Corresponding author

Correspondence to Brian D. Badgwell.

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Disclosures

Drs. Davis, Ikoma, Mansfield, Das, Minsky, Blum, Ajani, Bass, and Badgwell have no conflicts of interest or financial ties to this manuscript.

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Davis, C.H., Ikoma, N., Mansfield, P.F. et al. Comparison of laparoscopy versus mini-laparotomy for jejunostomy placement in patients with gastric adenocarcinoma. Surg Endosc 35, 6577–6582 (2021). https://doi.org/10.1007/s00464-020-08155-6

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  • DOI: https://doi.org/10.1007/s00464-020-08155-6

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