S. Ajmal1, T. Ng1, A. M. Blakely1, W. G. Cioffi1, T. J. Miner1 1Brown University School Of Medicine,Department Of Surgery,Providence, RI, USA
Introduction: Various modalities are employed to provide nutritional support to patients after esophagectomy for esophageal cancer. Routine Jejunostomy tubes are placed in patients with esophageal cancer to provide nutritional supplementation in perioperative setting. Total parenteral nutrition is also utilized when patients have complications or delayed oral intake. We sought to study the utility and complications associated with these nutritional support modalities.
Methods: We performed a retrospective chart review of all adult patients who underwent esophagectomy for esophageal cancer from 2001 to 2014 at a single tertiary care institution. We reviewed the utility of jejunostomy tube and complications associated with jejunostomy tubes.
Results: 182 patients underwent esophagectomy for esophageal cancer during the study period. Esphageal cancer types included 158 adenocarcinomas, 15 squamous cell carcinomas, 8 high grade dysplasias and 1 neuroendocrine tumor. 107 patients had Transhiatal resection, 55 had Ivor-lewis esophagectomy, 9 had Thoraco-abdominal resection and 10 patients had Three incision esophagectomy. 181 patients had a jejunostomy tube placed. At the time of discharge 88 (48.6%) patients were receiving nutrition through tube feeds. Out of these 88 patients, 34 (18.7%) had partial tube reliance while 53 (29.3%) had total tube reliance. 6 patients (3.3%) needed both jejunostomy tube feeds and total parenteral nutrition (TPN) while only one patient was just placed on TPN. Patient group that required tube feeds on discharge were more likely to have a complicated course than patients not on tube feeds (61 vs 12; p<0.05). Out of 181 patients with jejunostomy tubes, only 1 patient required surgical intervention due to catheter related complication. No mortality was reported due to catheter related complications.
Conclusion: Our data reveals that a significant number of patients require tube feeds at discharge. Serious morbidity secondary to jejunostomy feeding tube was rare. This further supports the current practice of placing routine feeding J-tubes for esophagectomies.