Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Thoracic Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China.
Ann Palliat Med. 2021 Apr;10(4):4232-4241. doi: 10.21037/apm-20-2519. Epub 2021 Apr 15.
Malnutrition dramatically increases the risk of postoperative complications and delays patient recovery. Therefore, a feeding jejunostomy tube (FJT) is routinely placed during esophagectomy to maintain the postoperative nutrition supply. However, recently published studies have questioned the need of a FJT in every esophageal cancer patient. Because most patients can resume oral intake shortly after surgery, the nutrition-providing function of a FJT becomes much less critical. In contrast, FJT-related complications could be severe.
Relevant publications were found out by systemic searching of four medical databases (PubMed, EMBASE, Medline, and Cochrane Center Register of Controlled Trials). By reading the titles and the abstracts, potentially relevant studies were screened from the search results. The incidence of postoperative complications and FJT-related complications were calculated and compared to evaluate the efficacy of a FJT.
Eighteen studies were included in the meta-analysis. The no-FJT group had a similar or even lower incidence of postoperative complications [anastomotic leakage (AL), pulmonary complications, and wound infections] compared with the FJT group. Ileus and FJT site infections were the most common FJT-related complications. The incidence of ileus was approximately 6% (95% CI: 3-12%), and over 63% of the patients with an ileus required re-operation to relieve the obstruction. The pooled mean rate of FJT site infections was 7% (95% CI: 6-9%). Approximately 7% of patients had dysfunction (obstruction or dislocation) of the jejunostomy tube (95% CI: 3-14%).
The non-selective placement of a FJT during esophagectomy provides few benefits to the patients and may even increase the risk of postoperative complications. Therefore, an intraoperative FJT should be selectively prescribed, but not routinely in the surgical treatment of esophageal cancer.
营养不良显著增加术后并发症的风险，并延迟患者康复。因此，在食管癌根治术中常规留置喂养空肠管（FJT）以维持术后营养供应。然而，最近发表的研究对每个食管癌患者都需要留置 FJT 提出了质疑。由于大多数患者在手术后不久即可恢复经口进食，因此 FJT 的营养供给功能变得不那么重要。相比之下，FJT 相关并发症可能很严重。
通过系统检索四个医学数据库（PubMed、EMBASE、Medline 和 Cochrane 中心对照试验注册库），查找相关文献。通过阅读标题和摘要，从检索结果中筛选出可能相关的研究。计算并比较术后并发症和 FJT 相关并发症的发生率，以评估 FJT 的疗效。
纳入了 18 项荟萃分析研究。与 FJT 组相比，无 FJT 组术后并发症（吻合口漏、肺部并发症和伤口感染）的发生率相似甚至更低。肠梗阻和 FJT 部位感染是最常见的 FJT 相关并发症。肠梗阻的发生率约为 6%（95%CI：3-12%），约 63%的肠梗阻患者需要再次手术以解除梗阻。FJT 部位感染的总发生率为 7%（95%CI：6-9%）。约 7%的患者出现空肠营养管功能障碍（梗阻或脱位）（95%CI：3-14%）。
食管癌根治术中非选择性留置 FJT 对患者益处有限，甚至可能增加术后并发症的风险。因此，术中应选择性留置 FJT，但不应作为食管癌的常规治疗方法。
