Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage

作者：Zhuang, Weitao; Wu, Hansheng; Liu, Huiling; Huang, Shujie; Wu, Yinghong; Deng, Cheng; Tian, Dan; Zhou, Zihao; Shi, Ruiqing; Chen, Gang; Piessen, Guillaume; Khaitan, Puja G.; Koyanagi, Kazuo; Ozawa, Soji; Qiao, Guibin^*

来源：Journal of Gastrointestinal Oncology, 2021, 12(2): 433-445.

DOI：10.21037/jgo-21-133

• Esophageal cancer (ESCA)
• esophagectomy
• feeding jejunostomy
• anastomotic leakage

Background: Feeding jejunostomy is widely used for enteral nutrition (EN) after esophagectomy; however, its risks and benefits are still controversial. We aimed to evaluate the short-term and long-term outcomes of feeding jejunal tube (FJT) in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) who were deemed high-risk for anastomotic leakage. @@@ Methods: We retrospectively analyzed 716 patients who underwent esophagectomy with (FJT group, n=68) or without ( control group, n=648) intraoperative placement of FJT. Propensity score matching (PSM) was used for the adjustment of confounding factors. Risk level for anastomotic leakage was determined for every patient after PSM. @@@ Results: Patients in the FJT group were at higher risk of anastomotic leakage (14.9% vs. 11.3%), and had a statistically non-significant increase of postoperative complications [31.3% vs. 21.8%, odds ratio (OR) = 1.139, 95% confidence interval (CI), 0.947-1.370, P=0.141] after PSM. Medical expenditure, length of postoperative hospital stay, and short-term mortality were similar between the FJT and control groups. Placement of FJT appeared to accelerate the recovery of anastomotic leakage (27.2 vs. 37.4 d, P=0.073). Patients in FJT group achieved comparable overall survival ( OS) both before [hazard ratio (HR) =0.850, P=0.390] and after (HR =0.797, P=0.292) PSM. @@@ Conclusions: FJT showed acceptable safety profile along with potential benefits for ESCC patients with a high presumed risk of anastomotic leakage. While FJT does not impact OS, placement of FJT should be considered in esophagectomy patients and tailored to individual patients based on their leak-risk profile.

• 单位
  汕头大学; 南方医科大学; 广东省人民医院