Abstract
Background
Although esophagectomy is the only curative option for esophageal cancer, the associated invasiveness is high. Nasogastric (NG) tube use may prevent complications; however, its utility remains unclear, and the decompression period depends on the doctor. This study aimed to reveal the effect of conventional versus early NG tube removal on postoperative complications after esophagectomy.
Methods
This single-center prospective randomized controlled clinical trial enrolled patients aged 20–80 years with histologically proven primary esophageal squamous cell carcinoma. Eighty patients admitted for transthoracic first-stage esophagectomy reconstructed with gastric conduit were randomly assigned (1:1) to the conventional and early NG tube removal groups. In the conventional NG tube removal group, the tube was removed on postoperative day (POD) 7; in the other, it was removed on POD 1. The occurrence rate of major complications, length of postoperative hospital stay, and NG tube reinsertion rate were compared between the groups.
Results
The incidence of postoperative major complications such as pneumonia, anastomotic leakage, recurrent nerve palsy and gastrointestinal bleeding, and the NG tube reinsertion rate was not different between the groups. However, recurrent nerve palsy was more commonly observed in the conventional removal group; this difference was not significant. In terms of postoperative pneumonia, tumor location and field of lymph node dissection were significant risk factors.
Conclusion
Although early NG tube removal did not reduce the rate of postoperative pneumonia, it could be performed safely. Hence, the NG tube can be removed earlier than conventional methods.
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Acknowledgements
The authors thank Kumiko Motooka, who belongs to the staff at the Department of Surgery in Keio University School of Medicine, for her help in the preparation of this report.
Funding
This study was funded by Takeda Pharmaceutical Company Limited.
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Hayashi, M., Kawakubo, H., Shoji, Y. et al. Analysis of the Effect of Early Versus Conventional Nasogastric Tube Removal on Postoperative Complications After Transthoracic Esophagectomy: A Single-Center, Randomized Controlled Trial. World J Surg 43, 580–589 (2019). https://doi.org/10.1007/s00268-018-4825-1
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DOI: https://doi.org/10.1007/s00268-018-4825-1