Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands.
Eur J Cardiothorac Surg. 2019 Oct 1;56(4):746-753. doi: 10.1093/ejcts/ezz063.
Adequate nutrition is challenging after oesophagectomy. A jejunostomy is commonly placed during oesophagectomy for nutritional support. However, some patients develop jejunostomy-related complications and the benefit over oral nutrition alone is unclear. This study aims to assess jejunostomy-related complications and the impact of intraoperative jejunostomy placement on weight loss and perioperative outcomes in patients with oesophageal cancer treated with minimally invasive Ivor Lewis oesophagectomy (MIE).
From a prospectively maintained database, patients were identified who underwent MIE with gastric reconstruction. Between 2007 and 2016, a jejunostomy was routinely placed during MIE. After 2016, a jejunostomy was not utilized. Postoperative feeding was performed according to a standardized protocol and similar for both groups. The primary outcomes were jejunostomy-related complications, relative weight loss at 3 and 6 months postoperative and perioperative outcomes, including anastomotic leak, pneumonia and length of stay, respectively.
A total of 188 patients were included, of whom 135 patients (72%) received a jejunostomy. Ten patients (7.4%) developed jejunostomy-related complications, of whom 30% developed more than 1 complication. There was no significant difference in weight loss between groups at 3 months (P = 0.73) and 6 months postoperatively (P = 0.68) and in perioperative outcomes (P-value >0.999, P = 0.591 and P = 0.513, respectively).
The use of a routine intraoperative jejunostomy appears to be an unnecessary step in patients undergoing MIE. Intraoperative jejunostomy placement is associated with complications without improving weight loss or perioperative outcomes. Its use should be tailored to individual patient characteristics. Early oral nutrition allows patients to maintain an adequate nutritional status.
食管切除术后营养摄入较为困难。在食管切除术中，通常会进行空肠造口术以提供营养支持。然而，部分患者会出现空肠造口相关并发症，且其相对于单纯口服营养的优势尚不明确。本研究旨在评估微创 Ivor Lewis 食管切除术（MIE）治疗食管癌患者中空肠造口相关并发症及术中放置空肠造口对体重减轻和围手术期结局的影响。
从一个前瞻性维护的数据库中，我们确定了 2007 年至 2016 年间接受 MIE 联合胃重建术的患者。在此期间，MIE 术中常规放置空肠造口。2016 年后，不再使用空肠造口。术后根据标准化方案进行喂养，两组的方案相似。主要结局为空肠造口相关并发症、术后 3 个月和 6 个月时的相对体重减轻以及围手术期结局，包括吻合口漏、肺炎和住院时间。
共纳入 188 例患者，其中 135 例（72%）患者接受了空肠造口术。10 例（7.4%）患者发生空肠造口相关并发症，其中 30%的患者发生了 1 种以上的并发症。两组患者在术后 3 个月（P=0.73）和 6 个月（P=0.68）时的体重减轻无显著差异，且围手术期结局也无差异（P 值均>0.999，P=0.591 和 P=0.513）。
在接受 MIE 的患者中，常规使用术中空肠造口似乎是不必要的步骤。术中放置空肠造口会导致并发症，而不会改善体重减轻或围手术期结局。应根据患者的个体特征来决定是否使用空肠造口。早期口服营养可以使患者保持足够的营养状态。
