Effect of Short-term vs Prolonged Nasogastric Decompression on Major Postesophagectomy Complications

Abstract

Hypothesis: Controversy exists over the need for prolonged nasogastric decompression after esophagectomy. We hypothesized that early removal of the nasogastric tube would not adversely affect major pulmonary complications and anastomotic leak rates. Design: Single-center, parallel-group, open-label, randomized (1:1) trial. Setting: A tertiary referral cancer center with high esophagectomy volume. Patients: One hundred fifty patients undergoing esophagectomy with gastric tube reconstruction. Interventions: Either conventional nasogastric decompression for 6 to 10 days (75 patients) or early removal (48 hours) of nasogastric tube (75 patients) with stratification for pyloric drainage and anastomotic technique. Main Outcome Measures: The primary (composite) end point was the occurrence of major pulmonary complications and anastomotic leaks. Secondary end points were the need for nasogastric tube reinsertion and patient discomfort scores. Analysis was performed on an intent-to-treat basis. Results: No significant differences were seen in the occurrence of the composite primary end point of major pulmonary and anastomotic complications between the delayed (14 of 75 patients [18.7%]) and early (16 of 75 patients [21.3%]) removal groups, respectively (P=.84). Nasogastric tube reinsertion was required more often (23 of 75 patients [30.7%] vs 7 of 75 patients [9.3%]) in the early group (P = .001). Mean patient discomfort scores were significantly higher in the delayed (ϩ1.3; 95% CI, 0.4-2.2; P = .006) than in the early removal group. Significantly more patients in the delayed removal group (26 of 75 patients [34.7%] vs 10 of 75 patients [13.3%] in the early removal group; P = .002) identified the nasogastric tube as the tube causing the most discomfort. Conclusions: Early removal of nasogastric tubes does not increase pulmonary or anastomotic complications after esophagectomy. Patient discomfort can be significantly reduced by early removal of the nasogastric tube.

Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy

“…Patients undergoing oesophagectomy are an ideal group for intervention as they have a high risk of postoperative sleep disturbance, and a relatively predictable postoperative course that includes a few days in intensive care. Postoperative pain and the discomfort associated with the nasogastric tube (usually kept in place for the first 7–10 postoperative days) can cause sleep disruption. In addition, patients who undergo oesophagectomy have all the psychological features of a patient with cancer, including somatization and psychological worries.…”

Sleep disturbances and quality of life in postoperative management after esophagectomy for esophageal cancer

“…In fact, apart from the risk of severe postoperative complications, postoperative pain, fatigue, and sleep disturbances can heavily affect a patient’s postoperative quality of life [8]. Following esophagectomy, sleep disruption can occur because of painful stimuli [9], constant discomfort caused by the nasogastric tube [10], and the constant noise and light in the ICU. Moreover, in the long term, almost all post-esophagectomy patients experience some kind of reflux when supine and heartburn may make it difficult for patients to lie flat causing sleep disruption [16].…”

“…Sleep disruption by painful stimuli is frequently observed both in clinical and experimental conditions [9]. Furthermore, in spite of recent evidence showing that an early removal does not affect anastomotic outcome, a nasogastric tube is usually kept in place for the first 7 to 10 postoperative days causing constant discomfort [10]. Finally, after esophagectomy patients usually spend at least 2 days in the ICU, where noise and full light are almost constant throughout the day.…”

Endoscopically assisted percutaneous transesophageal gastrotubing

“…Such complications are reported to occur in 2.4-3.2% of patients [10][11][12]. Longterm nasal tube insertion causes patients discomfort [13], and early removal has been recommended in a study comparing placement for only 48 h with placement for 6-10 days [14].…”