Al-Temimi Mohammed H, Dyurgerova Anya M, Kidon Michael, Johna Samir
Department of Surgery, Fontana Medical Center, CA.
Department of Surgery, Baylor University Medical Center, Dallas, TX.
Perm J. 2019;23. doi: 10.7812/TPP/18.210. Epub 2019 Aug 26.
Feeding jejunostomy (FJ) tubes are routinely placed during esophagectomy. However, their effect on immediate postoperative outcomes in this patient population is not clear.
To evaluate the effect of FJ tube placement during esophagectomy on postoperative morbidity and mortality.
The National Surgical Quality Improvement Program database was used to evaluate the effect of FJ tube placement during esophagectomy on 30-day postoperative morbidity and mortality rates. A propensity score-matched cohort was used to compare postoperative outcomes of patients with and without FJ tubes.
An FJ tube was placed in 45% of 2059 patients undergoing esophagectomy. The anastomotic leak rate was 13.5%. Patients with FJ tubes were more likely to have preoperative radiation therapy (59.6% vs 54.9%, p = 0.041), transhiatal esophagectomy (21.5% vs 19.2%, p = 0.012), a malignant diagnosis (93.2% vs 90.4%), and longer operative time (393 min vs 348 min, p < 0.001). In a case-matched cohort, mortality (2% vs 2.4%, p = 0.618) and severe morbidity (38.2% vs 34.6%, p = 0.128) were comparable between patients with and without FJ tubes. FJ tube placement was associated with higher overall morbidity (46% vs 38.6%, p = 0.002), superficial wound infection (6.3% vs 2.9%, p = 0.001), and return to the operating room (16.7% vs 12.5%, p = 0.016). In a subgroup of patients with anastomotic leak, FJ was associated with shorter hospital stay (20.1 days vs 24.3 days, p = 0.046).
These mixed findings support selective rather than routine FJ tube placement during esophagectomy.
空肠造口喂养（FJ）管通常在食管切除术期间放置。然而，其对该患者群体术后近期结局的影响尚不清楚。
评估食管切除术期间放置FJ管对术后发病率和死亡率的影响。
利用国家外科质量改进计划数据库评估食管切除术期间放置FJ管对术后30天发病率和死亡率的影响。采用倾向评分匹配队列比较有和没有FJ管的患者的术后结局。
2059例接受食管切除术的患者中有45%放置了FJ管。吻合口漏发生率为13.5%。放置FJ管的患者更可能接受术前放疗（59.6%对54.9%，p = 0.041）、经裂孔食管切除术（21.5%对19.2%，p = 0.012）、恶性诊断（93.2%对90.4%），且手术时间更长（393分钟对348分钟，p < 0.001）。在病例匹配队列中，有和没有FJ管的患者的死亡率（2%对2.4%，p = 0.618）和严重发病率（38.2%对34.6%，p = 0.128）相当。放置FJ管与更高的总体发病率（46%对38.6%，p = 0.002）、浅表伤口感染（6.3%对2.9%，p = 0.001）以及返回手术室（16.7%对12.5%，p = 0.016）相关。在吻合口漏患者亚组中，FJ管与住院时间缩短相关（20.1天对24.3天，p = 0.046）。
这些混合结果支持在食管切除术期间选择性而非常规放置FJ管。
