Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA.
J Surg Oncol. 2013 Jun;107(7):728-34. doi: 10.1002/jso.23324. Epub 2013 Feb 28.
Feeding jejunostomy tubes (J-tube) are often placed during gastrectomy for cancer to decrease malnutrition and promote delivery of adjuvant therapy. We hypothesized that J-tubes actually are associated with increased complications and do not improve nutritional status nor increase rates of adjuvant therapy.
One hundred thirty-two patients were identified from a prospectively maintained database that underwent gastric resection for gastric adenocarcinoma between 1/00 and 3/11 at one institution. Pre- and postoperative nutritional status and relevant intraoperative and postoperative parameters were examined.
Median age was 64 years (range 23-85). Forty-six (35%) underwent a total and 86 (65%) a subtotal gastrectomy. J-tubes were placed in 66 (50%) patients, 34 of whom underwent a subtotal and 32 a total gastrectomy. Preoperative nutritional status was similar between J-tube and no J-tube groups as measured by serum albumin (3.5 vs. 3.4 g/dL). Tumor grade, T, N, and overall stage were similar between groups. J-tube placement was associated with increased postop complications (59% vs. 41%, P = 0.04) and infectious complications (36% vs. 17%, P = 0.01), of which majority were surgical site infections. J-tubes were associated with prolonged length of stay (13 vs. 11 days; P = 0.05). There was no difference in postoperative nutritional status as measured by 30, 60, and 90-day albumin levels and the rate of receiving adjuvant therapy was similar between groups (J-tube: 61%, no J-tube: 53%, P = 0.38). Multivariate analyses revealed J-tubes to be associated with increased postop complications (HR: 4.8; 95% CI: 1.3-17.7; P = 0.02), even when accounting for tumor stage and operative difficulty and extent. Subset analysis revealed J-tubes to have less associated morbidity after total gastrectomy.
J-tube placement after gastrectomy for gastric cancer may be associated with increased postoperative complications with no demonstrable advantage in receiving adjuvant therapy. Routine use of J-tubes after subtotal gastrectomy may not be justified, but may be selectively indicated in patients undergoing total gastrectomy. A prospective trial is needed to validate these results.
在胃癌根治术中，常放置喂养空肠造口管（J 管）以减少营养不良并促进辅助治疗的进行。我们假设 J 管实际上与增加并发症有关，并且不能改善营养状况或增加辅助治疗的比例。
我们从一家机构的前瞻性维护数据库中确定了 132 名接受胃切除术治疗胃腺癌的患者，这些患者的手术时间为 2000 年 1 月至 2011 年 3 月。检查了术前和术后的营养状况以及相关的术中术后参数。
中位年龄为 64 岁（范围 23-85 岁）。46 例（35%）行全胃切除术，86 例（65%）行胃次全切除术。66 例（50%）患者放置了 J 管，其中 34 例行胃次全切除术，32 例行全胃切除术。血清白蛋白测量显示，J 管组和非 J 管组的术前营养状况相似（3.5 vs. 3.4 g/dL）。两组的肿瘤分级、T、N 和总分期相似。J 管放置与术后并发症增加相关（59% vs. 41%，P = 0.04）和感染性并发症（36% vs. 17%，P = 0.01），其中大多数为手术部位感染。J 管与住院时间延长相关（13 天 vs. 11 天；P = 0.05）。术后 30、60 和 90 天白蛋白水平以及接受辅助治疗的比例在两组之间无差异（J 管组：61%，非 J 管组：53%，P = 0.38）。多变量分析显示，J 管与术后并发症增加相关（HR：4.8；95%CI：1.3-17.7；P = 0.02），即使考虑到肿瘤分期、手术难度和范围。亚组分析显示，在全胃切除术后，J 管的并发症发生率较低。
在胃癌根治术中放置 J 管可能与术后并发症增加有关，而在接受辅助治疗方面没有明显优势。在胃次全切除术后常规使用 J 管可能没有理由，但在接受全胃切除术的患者中可能有选择地使用。需要进行前瞻性试验来验证这些结果。
