A Prospective Randomized Trial Comparing Jejunostomy and Nasogastric Feeding in Minimally Invasive McKeown Esophagectomy
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ORIGINAL ARTICLE
A Prospective Randomized Trial Comparing Jejunostomy and Nasogastric Feeding in Minimally Invasive McKeown Esophagectomy Zheng Tao 1 & Yan Zhang 1 & Shaojin Zhu 1 & Zhengzheng Ni 1 & Qi You 1 & Xiaodong Sun 1 & Dong Xu 1 Received: 13 June 2019 / Accepted: 28 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Early postoperative enteral nutrition is recommended for patients undergoing esophagectomy; however, the optimum method of tube feeding remains controversial. Thus, the aim of this study is to assess two common enteral nutrition methods after minimally invasive McKeown esophagectomy. Methods A randomized controlled trial was performed with 120 patients who underwent minimally invasive McKeown esophagectomy from January 2017 to December 2018. The patients were randomly divided so that 58 patients were in the jejunostomy feeding (JF) group and 62 patients were in the nasogastric feeding (NF) group. The postoperative outcomes, including complications, nutritional status, quality of life, and survival rate, were studied and used as the main parameters to compare the abovementioned tube feeding methods. Results The incidence of overall complications was equivalent between the two groups (P = 0.625), except for bowel obstruction (which occurred 4 times in the JF group but did not occur in the NF group). In the first month after surgery (postoperative month 1, POM1), a significantly higher body mass index (BMI) was observed in the JF group (23.6 ± 3.2) than in the NF group (20.9 ± 3.5, P = 0.032). The global quality-of-life scores were better in the JF group than in the NF group (P < 0.001). In addition, there were no significant differences between the two groups in terms of disease-free survival (DFS) (P = 0.816) and overall survival (OS) (P = 0.564). Conclusions Compared with NF, JF provides more safety, efficacy, and utility as nutritional support for minimally invasive McKeown esophagectomy patients who have a high incidence of anastomotic leakage. However, the higher risk of intestinal obstruction after JF requires attention. Keywords Esophagectomy . Jejunostomy . Enteral nutrition . Complications
Introduction Nutrition and complications are two key factors that restrict the rapid recovery of patients who undergo esophagectomy. Reasonable nutrition support will help improve the nutritional status and reduce the risk of complications in postoperative patients. Thus, early postoperative enteral nutrition is
* Dong Xu [email protected] Zheng Tao [email protected] 1
Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
recommended for patients with esophageal cancer after surgery.1 In comparison with parenteral nutrition, enteral nutrition has some advantages, such as fewer incidences of complications and being more economical and safer. 2 Furthermore, parenteral nutrition can be added when enteral nutrition is not satisfactory, and the combination of enteral nutrition and parenteral nutrition is able to effect
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