Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies

Blakely, Andrew M.; Ajmal, Saad; Sargent, Rachel E.; Ng, Thomas T; Miner, Thomas J.

doi:10.4240/wjgs.v9.i2.53

Cited by 13 publications

(8 citation statements)

References 18 publications

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“…Jejunostomy‐related complications were the main reason for relaparotomy. In this series, the rate of such complications (3 of 26 patients, 12 per cent) is at the top end of rates reported from other series (1–13 per cent), the confidence interval, however is broad. The surgeons, their experience (no learning curve issues), type of procedure and tubes were the same over the years.…”

Section: Discussioncontrasting

confidence: 53%

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Outcomes after prophylactic gastrectomy for hereditary diffuse gastric cancer

Kaaij

Kessel

Dieren

et al. 2018

British Journal of Surgery

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Background: Patients with hereditary diffuse gastric cancer and a CDH1 mutation have a 60-80 per cent lifetime risk of developing diffuse gastric cancer. Total prophylactic gastrectomy eliminates this risk, but is associated with considerable morbidity. The effectiveness (removal of all gastric mucosa) and outcomes of this procedure were evaluated retrospectively.Methods: All consecutive individuals undergoing a prophylactic gastrectomy for a CDH1 mutation or gastric signet ring cell foci at the authors' institute between 2005 and 2017 were included.Results: In 25 of 26 patients, intraoperative frozen-section examination (proximal resection margin) was used to verify complete removal of gastric mucosa. All definitive resection margins were free of gastric mucosa, but only after the proximal margin had been reresected in nine patients. In the first year after surgery, five of the 26 patients underwent a relaparotomy for adhesiolysis (2 patients) or jejunostomy-related complications (3 patients). Six patients were readmitted to the hospital within 1 year for nutritional and/or psychosocial support (4 patients) or surgical reintervention (2 patients). Mean weight loss after 1 year was 15 (95 per cent c.i. 12 to 18) per cent. For the 25 patients with a follow-up at 1 year or more, functional complaints were reported more frequently at 1 year than at 3 months after the operation: bile reflux (15 versus 11 patients respectively) and dumping (11 versus 7 patients). The majority of patients who worked or studied before surgery (15 of 19) had returned fully to these activities within 1 year. Conclusion:The considerable morbidity and functional consequences of gastrectomy should be considered when counselling individuals with an inherited predisposition to diffuse gastric cancer. Intraoperative frozen-section examination is recommended to remove all risk-bearing gastric mucosa.Presented at the multidisciplinary consensus meeting on hereditary diffuse gastric cancer,

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Section: Discussioncontrasting

confidence: 53%

“…The surgeons, their experience (no learning curve issues), type of procedure and tubes were the same over the years. Whether or not a feeding jejunostomy should be placed routinely is an ongoing debate in oesophagogastric cancer surgery. In the present series, patients needed their feeding tube for approximately 2 months.…”

Section: Discussionmentioning

confidence: 87%

Outcomes after prophylactic gastrectomy for hereditary diffuse gastric cancer

Kaaij

Kessel

Dieren

et al. 2018

British Journal of Surgery

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“…Regarding complications related to jejunostomy, most of the reports are related to its performance after major gastrointestinal procedures for postoperative nutritional support[ 4 , 5 , 20 , 21 ]. Common surgical complications include loss or obstruction of the tube and local leakage of its content.…”

Section: Discussionmentioning

confidence: 99%

Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score

Ramos¹,

Pereira²,

Dias³

et al. 2021

WJCO

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BACKGROUND Clinical stage IV gastric cancer (GC) may need palliative procedures in the presence of symptoms such as obstruction. When palliative resection is not possible, jejunostomy is one of the options. However, the limited survival of these patients raises doubts about who benefits from this procedure. AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy. METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy. Eleven preoperative clinical variables were selected to define the score categories, with 90-d mortality as the main outcome. After randomization, patients were divided equally into two groups: Development (J1) and validation (J2). The following variables were used: Age, sex, body mass index (BMI), American Society of Anesthesiologists classification (ASA), Charlson Comorbidity index (CCI), hemoglobin levels, albumin levels, neutrophil-lymphocyte ratio (NLR), tumor size, presence of ascites by computed tomography (CT), and the number of disease sites. The score performance metric was determined by the area under the receiver operating characteristic (ROC) curve (AUC) to define low and high-risk groups. RESULTS Of the 363 patients with clinical stage IVCG, 80 (22%) patients underwent jejunostomy. Patients were predominantly male (62.5%) with a mean age of 62.4 years old. After randomization, the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score. The high NLR had the highest value. The ROC curve derived from these pooled parameters had an AUC of 0.712 (95%CI: 0.537–0.887, P = 0.022) to define risk groups. In the validation cohort, the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756, (95%CI: 0.598–0.915, P = 0.006). According to the cutoff, in the validation cohort BMI less than 18.5 kg/m 2 ( P < 0.001), CCI ≥ 1 ( P = 0.001), ASA III/IV ( P = 0.002), high NLR ( P = 0.012), and the presence of ascites on CT exam ( P = 0.004) were significantly associated with the high-risk group. The risk groups showed a significant association with first-line ( P = 0.012), second-line chemotherapy ( P = 0.009), 30-d ( P = 0.013), and 90-d mortality ( P < 0.001). CONCLUSION The scoring system developed with 11 variables related to patient’s performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.

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“…We did not separate trans-hiatal and Ivor-Lewis oesophagectomy, but it is possible that there could be a difference between these two groups as mediastinitis from a chest leak is considered to be a more morbid complication, 13 and therefore potentially more likely to have a covering feeding jejunostomy. 14 The length of time that a feeding tube would remain in place after surgery is also highly variable. This most likely represents many factors that affect decision making: patient weight, tolerability of oral diet, operative approach and adjuvant therapy were the most frequent responses.…”

Section: Discussionmentioning

confidence: 99%

Feeding jejunostomy in upper gastrointestinal resections: a UK-wide survey

Ireland

Jaunoo

2020

annals

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Introduction The usage of a feeding jejunostomy has been a well-established practice in maintaining nutrition in patients undergoing resections for upper gastrointestinal cancer. As surgical technique has evolved, together with the adoption of enhanced recovery after surgery pathways, the routine insertion of feeding jejunostomy tubes appears to be changing. Materials and methods A survey was constructed using Google Forms. The link was distributed to consultant upper gastrointestinal surgeons via the Association of Upper Gastrointestinal Surgeons’ membership database. Results were collated and analysed using Microsoft Excel. Results A total of 55 responses were received from 28 units across the UK; 27 respondents (49.1%) no longer routinely use feeding jejunostomy in upper gastrointestinal resections, oesophagectomy or gastrectomy. The most common primary feeding modality used by these respondents was oral diet 17 (65.4%), with total parenteral nutrition (19.2%) and nasojejunal (11.5%) routes also being used. Respondents who used feeding jejunostomies inserted them primarily for oesophagectomy (n = 27; 96.4%), with fewer surgeons using them in extended total gastrectomy (n = 12; 42.9%) and total gastrectomy (n = 11; 39.3%). Of the total, 20 surgeons (71.4%) would insert the jejunostomy using an open approach, with 19 (67.9%) employing a Witzel tunnel. Eleven respondents (39.3%) would continue feeding via the jejunostomy after discharge. Some 24 responders thought that feeding jejunostomies did not facilitate the enhanced recovery after surgery pathway (strongly and slightly disagree), whereas 17 considered that they did (strongly and slightly agree); 13 responders did not have strong views either way. Conclusions There is a split in current practice regarding the usage of feeding jejunostomies. There is also a division of opinion on the role of feeding jejunostomy in enhanced recovery after surgery.

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Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies

Cited by 13 publications

References 18 publications

Outcomes after prophylactic gastrectomy for hereditary diffuse gastric cancer

Outcomes after prophylactic gastrectomy for hereditary diffuse gastric cancer

Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score

Feeding jejunostomy in upper gastrointestinal resections: a UK-wide survey

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