The enteral feeding tube access route in esophageal cancer surgery

Abstract

Background and aims：Feeding catheter jejunostomy is useful as an access route for early enteral nutrition during esophageal cancer surgery；however, it may be a cause of the postoperative bowel obstruction associated with feeding jejunostomy（BOFJ）. To avoid BOFJ, we have introduced the feeding catheter duodenostomy through the round ligament since 2018. The aim of this study was to compare the incidence of BOFJ and postoperative body weight change between feeding catheter jejunostomy and duodenostomy.
Patients and Methods：A total of 109 patients who underwent thoracoscopic esophagectomy and gastric tube reconstruction for esophageal cancer between March 2013 and November 2020 were included. Patient backgrounds（age, sex, preoperative weight, BMI, cancer stage, preoperative treatment）, surgical outcomes （operative time, blood loss）, postoperative complications（wound infection, pneumonia, anastomotic leakage, BOFJ）, and body weight change at 1, 3, 6, and 12 months after surgery were compared, and categorized into jejunostomy（J）and duodenostomy（D）groups.
Results：The D group consisted of 35 patients. Age, sex, weight, BMI, cancer stage, operative time, postoperative complications and duration of tube placement were not significantly different between the two groups. The D group had significantly less preoperative chemotherapy（45.7％ vs. 78.4％；P＝0.001）and lower operative blood loss volume（150mL vs. 120mL；P＝0.046）. There were 12 cases of BOFJ, all of which occurred in the J group. Postoperatively, the D group had a significantly lower weight loss ratio than the J group at 1 month after surgery（93.9％ vs. 91.8％；P＝0.039）.
Conclusion：In thoracoscopic esophagectomy, feeding duodenostomy may prevent bowel obstruction and reduce the weight loss at the early postoperative period without prolonging the operative time compared with feeding catheter jejunostomy.