K.V. Grotheer1, J. Fredette2, S.H. Greco3, A.S. Porpiglia3, S.S. Reddy3, J.M. Farma3, A.M. Villano3 1New Jersey Medical School, Department Of Surgery, Newark, NJ, USA 2Fox Chase Cancer Center, Division Of Biostatistics And Bioinformatics, Philadelphia, PA, USA 3Fox Chase Cancer Center, Division Of Surgical Oncology, Philadelphia, PA, USA
Introduction: Curative intent treatment for gastric cancer carries a high potential for malnutrition, gastrointestinal side effects, and surgical complications. The most recent 2024 National Comprehensive Cancer Network guidelines cite preference for feeding jejunostomy tubes (JT) at definitive resection to provide nutritional support. There are sparse data describing current trends in JT utilization, nor the impact on surgical complications.
Methods: The National Surgical Quality Improvement Program Participate User Files (2007-2021) were retrospectively reviewed to identify all gastrectomy performed for gastric adenocarcinoma. International classification of disease (ICD) codes classified patients with and without JT placement during gastrectomy. Subgroup analyses were conducted based on gastrectomy type (partial (PG) and total (TG)). Time trend analyses described JT placement over the study period. Multivariable regression controlling for covariates explored factors independently associated with JT placement and 30-day postoperative complications.
Results: In sum, 8187 patients underwent gastrectomy for gastric cancer. Of these, 1344 (16.4%) underwent concurrent JT placement and 6843 (83.6%) did not. From 2007 to 2021, rates of JT placement experienced a steep decline following 2011, averaging over 20% to under 10% currently (Figure). A similar decline post-2011 occurred irrespective of gastrectomy type, with JT placement being generally more common in TG (32% vs. 9% in PG) (Figure). Factors independently associated with JT placement included race (Asian OR 0.57, 95%CI 0.46 – 0.70; Black OR 0.81, 95%CI 0.68 – 0.97), lower BMI (BMI, OR 0.98, 95%CI 0.97 – 0.99), and total gastrectomy (OR 4.85, 95%CI 4.27 – 5.51). Any complication within 30 days postoperatively occurred in 29.7% of patients overall, 26.6% following PG, and 36.2% following TG. Amongst the overall cohort, multivariable regression demonstrated a higher risk of any 30-day postoperative complication with age (OR 1.08, 95%CI 1.05-1.10), moribund ASA classification (OR 2.42, 95%CI 1.36-4.31), higher BMI (OR 1.01, 95%CI 1.00 – 1.02), total gastrectomy (OR 1.60, 95%CI 1.43 – 1.78), and feeding JT placement (OR1.31, 95%CI 1.15 – 1.49). Feeding JT placement was no longer associated with 30-day complications amongst TG (OR1.15, 95%CI 0.96 – 1.36) but persisted in PG (OR 1.56, 95%CI 1.28 – 1.90).
Conclusion: JT placement at the time of gastrectomy is not protective against perioperative complications and may confer higher risk in PG. JT use has significantly declined in the modern era despite guideline recommendations, thus further research is needed to identify which patients may benefit to harmonize guidelines with practice.