Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX, 77030, USA.
Surg Endosc. 2021 Dec;35(12):6577-6582. doi: 10.1007/s00464-020-08155-6. Epub 2020 Nov 10.
Optimal nutrition is challenging for patients with gastric and gastroesophageal adenocarcinoma and often requires feeding tube placement prior to preoperative therapy. Feeding jejunostomy (FJ) placement via mini-laparotomy is technically easier to perform than laparoscopic FJ. The purpose of this study was to compare outcomes in patients with gastric adenocarcinoma undergoing laparoscopic versus mini-laparotomy FJ placement.
A retrospective cohort study was performed of patients with gastric adenocarcinoma receiving laparoscopic versus mini-laparotomy FJ at a single tertiary referral center from 2000 to 2018. 30-day outcomes included complications, conversion to laparotomy, reoperation, length of stay, and readmission.
A total of 656 patients met the inclusion criteria and were studied. The majority of patients were male (68.1%) with a mean age of 60.6 years. The difference in surgical approach remained relatively stable over time. Overall, 82 (12.5%) patients experienced complications, and three (0.5%) patients died postoperatively. While readmission and conversion to open laparotomy did not differ between groups, overall complications (10.5% vs. 20.8%, p = 0.002), Clavien-Dindo ≥ 3 complications (4.0% vs. 8.9%, p = 0.021), length of stay (4.1 vs. 5.6 days, p < 0.001), and reoperation (0.9% vs. 4.0%, p = 0.002) favored the laparoscopic over mini-laparotomy group.
The current study helps clarify the risk of FJ placement in patients with gastric adenocarcinoma requiring nutritional support. Laparoscopic FJ placement has lower overall morbidity and length of stay compared to mini-laparotomy. However, caution is needed in preventing and identifying the rare causes of postoperative mortality that may be associated with laparoscopic FJ placement.
胃和胃食管腺癌患者的最佳营养极具挑战性，通常需要在术前治疗前放置喂养管。经迷你腹腔镜进行空肠造口术（FJ）比腹腔镜 FJ 更易于操作。本研究旨在比较胃腺癌患者接受腹腔镜与迷你腹腔镜 FJ 放置的治疗结果。
对 2000 年至 2018 年期间在一家三级转诊中心接受腹腔镜与迷你腹腔镜 FJ 治疗的胃腺癌患者进行了回顾性队列研究。30 天的结果包括并发症、中转开腹、再次手术、住院时间和再入院。
共有 656 名符合纳入标准的患者接受了研究。大多数患者为男性（68.1%），平均年龄为 60.6 岁。手术方法的差异在整个研究期间相对稳定。总的来说，82 名（12.5%）患者发生了并发症，3 名（0.5%）患者术后死亡。尽管两组间的再入院和中转开腹无差异，但总体并发症（10.5%比 20.8%，p=0.002）、Clavien-Dindo≥3 级并发症（4.0%比 8.9%，p=0.021）、住院时间（4.1 比 5.6 天，p<0.001）和再次手术（0.9%比 4.0%，p=0.002）均有利于腹腔镜组。
本研究有助于阐明胃腺癌患者接受营养支持时行 FJ 放置的风险。与迷你腹腔镜相比，腹腔镜 FJ 放置的总体发病率和住院时间更低。然而，在预防和识别可能与腹腔镜 FJ 放置相关的罕见术后死亡原因时需要谨慎。
