Skip to main content

Advertisement

SpringerLink
Log in

A Prospective Randomized Trial Comparing Jejunostomy and Nasogastric Feeding in Minimally Invasive McKeown Esophagectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Early postoperative enteral nutrition is recommended for patients undergoing esophagectomy; however, the optimum method of tube feeding remains controversial. Thus, the aim of this study is to assess two common enteral nutrition methods after minimally invasive McKeown esophagectomy.

Methods

A randomized controlled trial was performed with 120 patients who underwent minimally invasive McKeown esophagectomy from January 2017 to December 2018. The patients were randomly divided so that 58 patients were in the jejunostomy feeding (JF) group and 62 patients were in the nasogastric feeding (NF) group. The postoperative outcomes, including complications, nutritional status, quality of life, and survival rate, were studied and used as the main parameters to compare the abovementioned tube feeding methods.

Results

The incidence of overall complications was equivalent between the two groups (P = 0.625), except for bowel obstruction (which occurred 4 times in the JF group but did not occur in the NF group). In the first month after surgery (postoperative month 1, POM1), a significantly higher body mass index (BMI) was observed in the JF group (23.6 ± 3.2) than in the NF group (20.9 ± 3.5, P = 0.032). The global quality-of-life scores were better in the JF group than in the NF group (P < 0.001). In addition, there were no significant differences between the two groups in terms of disease-free survival (DFS) (P = 0.816) and overall survival (OS) (P = 0.564).

Conclusions

Compared with NF, JF provides more safety, efficacy, and utility as nutritional support for minimally invasive McKeown esophagectomy patients who have a high incidence of anastomotic leakage. However, the higher risk of intestinal obstruction after JF requires attention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Smeets BJJ, Luyer MDP. Nutritional interventions to improve recovery from postoperative ileus. Current Opinion in Clinical Nutrition & Metabolic Care. 2018; 21(5):394–398.

    Article  Google Scholar 

  2. Zeng S, Xue Y, Zhao J, et al. Total parenteral nutrition versus early enteral nutrition after cystectomy: a meta-analysis of postoperative outcomes. Int Urol Nephrol. 2019;51(1):1–7.

    Article  Google Scholar 

  3. Ye Y, Xu Y, Fu Q, et al. Enteral Nutrition Support Does Not Improve PNI in Radiotherapy Patients with Locally Advanced Esophageal Cancer[J]. Nutrition and Cancer. 2019;71(2):223–229.

    Article  CAS  Google Scholar 

  4. Martin-Richard M, Díaz Beveridge R, Arrazubi V, et al. SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016). Clinical and Translational Oncology. 2016;18(12):1179–1186.

    Article  CAS  Google Scholar 

  5. Pinto E, Cavallin F, Scarpa M. Psychological support of esophageal cancer patient? J Thorac Dis. 2019; 11(5):S654-S662.

    Article  Google Scholar 

  6. Bottomley A, Tridello G, Coens C, et al. An international phase 3 trial in head and neck cancer: quality of life and symptom results: EORTC 24954 on behalf of the EORTC Head and Neck and the EORTC Radiation Oncology Group. Cancer. 2014; 120(3):390–398.

    Article  Google Scholar 

  7. Yuen MTY, Tsang RK, Wong IYH, et al. Long-term pharyngeal dysphagia after esophagectomy for esophageal cancer-an investigation using videofluoroscopic swallow studies. Dis Esophagus. 2019; 32(1).

  8. McTiernan A, Friedenreich CM, Katzmarzyk PT, et al. Physical Activity in Cancer Prevention and Survival: A Systematic Review. Med Sci Sports Exerc. 2019; 51(6):1252–1261.

    Article  Google Scholar 

  9. Steenhagen E. Preoperative nutritional optimization of esophageal cancer patients. J Thorac Dis. 2019; 11(5):S645-S653.

    Article  Google Scholar 

  10. Mcclave SA, Martindale R. Why Do Current Strategies for Optimal Nutritional Therapy Neglect the Microbiome? Nutrition. 2019; 60:100–105.

    Article  Google Scholar 

  11. Weijs TJ, Hwj VE, Ruurda JP, et al. Routine jejunostomy tube feeding following esophagectomy. Journal of Thoracic Disease. 2017; 9(S8):S851-S860.

    Article  Google Scholar 

  12. Álvarez-Sarrado, Eduardo, Mingol Navarro F, et al. Feeding Jejunostomy after esophagectomy cannot be routinely recommended. Analysis of nutritional benefits and catheter-related complications. The American Journal of Surgery. 2018; 217(1):114–120.

    Article  Google Scholar 

  13. Xin F, Mzee SAS, Botwe G, et al. Short-term evaluation of immune levels and nutritional values of EN versus PN in gastric cancer: a systematic review and a meta-analysis. World J Surg Oncol. 2019 Jul 3;17(1):114.

    Article  Google Scholar 

  14. Choi AH, O’Leary MP, Merchant SJ, et al. Complications of Feeding Jejunostomy Tubes in Patients with Gastroesophageal Cancer. Journal of Gastrointestinal Surgery. 2017; 21(2):259–265.

    Article  Google Scholar 

  15. Klevebro F, Johar A, Lagergren J, et al. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus. 2019;32(7):1–6.

    Article  Google Scholar 

  16. Torres Junior LG, de Vasconcellos Santos FA, Correia MI. Randomized clinical trial: nasoenteric tube or jejunostomy as a route for nutrition after major upper gastrointestinal operations. World J Surg. 2014;38(9):2241–2246.

    Article  Google Scholar 

  17. Akiyama Y, Iwaya T, Endo F et al. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis. 2018; 10(12):6854–6862.

    Article  Google Scholar 

  18. Aaronson NK, Ahmedzai S, Bergman B et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–376.

    Article  CAS  Google Scholar 

  19. Bedell A, Taft TH, Keefer L et al. Development of the Northwestern Esophageal Quality of Life Scale: A Hybrid Measure for Use Across Esophageal Conditions. American Journal of Gastroenterology. 2016; 111(4):493–9.

    Article  Google Scholar 

  20. The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine.1995; 41(10):1403–9.

  21. Derogar M, Orsini N, Sadr-Azodi O et al. Influence of Major Postoperative Complications on Health-Related Quality of Life Among Long-Term Survivors of Esophageal Cancer Surgery. Journal of Clinical Oncology 2012, 30(14):1615–1619.

    Article  Google Scholar 

  22. Anandavadivelan P, Martin L, Djarv T, et al. Nutrition Impact Symptoms Are Prognostic of Quality of Life and Mortality after Surgery for Oesophageal Cancer. Cancers (Basel). 2018;10(9).

  23. Scarpa M, Valente S, Alfieri R, et al. Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World J Gastroenterol. 2011; 17:4660–74.

    Article  Google Scholar 

  24. Svetanoff WJ, McGahan R, Singhal S, et al. Quality of life after esophageal resection. Patient Relat Outcome Meas. 2018;9:137–146.

    Article  Google Scholar 

  25. Weksler B, Sharma P, Moudgill N, et al. Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy. Diseases of the Esophagus. 2012, 25(5):403–409.

    Article  CAS  Google Scholar 

  26. Blakely AM, Ajmal S, Sargent RE, et al. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg. 2017; 9(2):53.

    Article  Google Scholar 

  27. Fukuzawa J, Terashima H, Ohkohchi N. Early postoperative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg. 2007;31(6):1234–1239.

    Article  Google Scholar 

  28. Rizzo SM, Douglas JW, Lawrence JC. Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review. Nutr Clin Pract. 2019; 34(3):359–370.

    Article  Google Scholar 

  29. Fenton JR, Bergeron EJ, Coello M, et al. Feeding Jejunostomy Tubes Placed During Esophagectomy: Are They Necessary? Annals of Thoracic Surgery. 2011; 92(2):504–512.

    Article  Google Scholar 

  30. Parlar-Chun R, Lafferty-Prather M, Gonzalez V et al. Protocol: randomised trial to compare nasoduodenal tube and nasogastric tube feeding in infants with bronchiolitis on high-flow nasal cannula; Bronchiolitis and High-flow nasal cannula with Enteral Tube feeding Randomised (BHETR) trial. BMJ Open. 2019; 9(5):e025405.

    PubMed  PubMed Central  Google Scholar 

  31. Hao Wang, Qun Hao, Meng Wang et al. Esophagojejunostomy after laparoscopic total gastrectomy by OrVilTM or hemi-double stapling technique. World J Gastroenterol. 2015; 21(29): 8943–8951.

    Article  Google Scholar 

Download references

Funding

This study was supported by the Nature and Science Fund from Wannan Medical College, CN (Grant NO. WK2019F23,WK2018ZF10).

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China

    Zheng Tao, Yan Zhang, Shaojin Zhu, Zhengzheng Ni, Qi You, Xiaodong Sun & Dong Xu

Authors
  1. Zheng Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaojin Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhengzheng Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qi You
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaodong Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Zheng Tao and Dong Xu contributed to the conception/design of the work; Qi You and Xiaodong Sun contributed to the acquisition of data; Yan Zhang and Shaojin Zhu contributed to the analysis/interpretation of data; Zheng Tao and Zhengzheng Ni drafted the manuscript. All authors approved the final version submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Dong Xu.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests and agree to publish this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tao, Z., Zhang, Y., Zhu, S. et al. A Prospective Randomized Trial Comparing Jejunostomy and Nasogastric Feeding in Minimally Invasive McKeown Esophagectomy. J Gastrointest Surg 24, 2187–2196 (2020). https://doi.org/10.1007/s11605-019-04390-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04390-y

Keywords

Search

Navigation