Enteral Feeding Access Has an Impact on Outcomes for Patients with Esophageal Cancer Undergoing Esophagectomy: An Analysis of SEER-Medicare
Optimal nutrition after esophagectomy is challenging due to alterations in eating, both from the tumor and during surgical recovery. Enteral nutrition via feeding tube is commonly used. The impact of feeding tubes on post-esophagectomy outcomes was examined in a large national data set.
Patients with esophageal cancer (1998–2013) undergoing esophagectomy were extracted from the Surveillance Epidemiology and End Results-Medicare database. Chi-square and t tests were used to compare categorical and continuous variables. Time trend analyses were performed with Cochran–Armitage survival using log-rank and multivariable analysis with generalized linear modeling.
The study examined 2495 patients. The majority had enteral feeding access (71%, n = 1794) during the perioperative period. Mortality among the patients with feeding tubes was lower at 30 days (5.4% vs 8.4%), 60 days (9.0% vs 13.0%), and 90 days (12.2% vs 15.8%). In the multivariable analysis, the patients with feeding tubes had improved short-term survival at 30 days (odds ratio [OR], 0.65, 95% confidence interval [CI], 0.46–0.93), 60 days (OR, 0.64; 95% CI, 0.49–0.85), and 90 days (OR, 0.70; 95% CI, 0.54–0.90). The hospital stay was shorter for the patients undergoing enteral feeding tube placement (17.9 vs 19.5 days; p = 0.04). Discharge destination (home vs health care facility) showed no difference.
Feeding tubes in patients undergoing esophagectomy were associated with an increase in short-term survival up to 90 days after surgery. Feeding tube placement was not associated with higher rates of non-home discharges and did not prolong the hospital stay.
There are no conflicts of interest.
- 9.Gerndt SJ, Orringer MB. Tube jejunostomy as an adjunct to esophagectomy. Surgery. 1994;115:164–9.Google Scholar
- 10.Heslin MJ, Latkany L, Leung D, et al. A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg. 1997;226:567–77; discussion 577–80.Google Scholar
- 13.Kobayashi T, Oshima K, Yokobori T, et al. Perioperative nutriture in esophageal cancer patients undergoing esophagectomy. Hepatogastroenterology. 2013;60:1311–6.Google Scholar
- 15.Scarpa M, Cavallin F, Noaro G, et al. Impact of jejunostomy during esophagectomy for cancer on health related quality of life. Chin J Cancer Res. 2014;26:678–84.Google Scholar
- 20.Franch-Arcas G, Gonzalez-Sanchez C, Gomez-Alonso A. Questions about the evidence regarding the benefits of enteral nutrition enriched with eicosapentaenoic acid in esophageal cancer surgery. Ann Surg. 2012;255:e14–5; author reply e16.Google Scholar
- 27.Xiao-Bo Y, Qiang L, Xiong Q, et al. Efficacy of early postoperative enteral nutrition in supporting patients after esophagectomy. Minerva Chir. 2014;69:37–46.Google Scholar
- 31.Starr B, Davis S, Ayala-Peacock D, et al. Reassessment of the role of enteral tube feedings for patients with esophageal cancer. Am Surg. 2014;80:752–8.Google Scholar