Naso-gastric or naso-jejunal decompression after partial distal gastrectomy for gastric cancer. Final results of a multicenter prospective randomized trial

Pacelli, Fabio; Rosa, Fausto; Marrelli, Daniele; Morgagni, Paolo; Framarini, Massimo; Cristadoro, Luigi; Pedrazzani, Corrado; Casadei, Riccardo; Cozzaglio, Luca; Covino, Marcello; Donini, Annibale; Roviello, Franco; Manzoni, Giovanni De; Doglietto, Giovanni Battista

doi:10.1007/s10120-013-0319-x

Cited by 19 publications

(12 citation statements)

References 17 publications

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“…Our search for papers on nasogastric/nasojejunal decompression for gastrectomy published in or after 2014 showed two RCT and two meta‐analyses . These papers strongly supported the recommendation of the guidelines.…”

Section: Consensus Guidelines For Enhanced Recovery After Gastrectomysupporting

confidence: 53%

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Yamagata

Yoshikawa

Yura

et al. 2019

Annals of Gastroent Surgery

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Since the late 1990s, perioperative care through the enhanced recovery after surgery (ERAS, European Society for Clinical Nutrition and Metabolism [ESPEN]) program has spread. ERAS protocols aim to reduce surgical complications, improving postoperative outcomes and thereby saving resources by addressing various clinical elements through a multidisciplinary approach or based on evidence. In the field of gastric cancer, the philosophy of ERAS has gradually become accepted and, in 2014, consensus guidelines for enhanced recovery after gastrectomy were published. These guidelines consist of “procedure‐specific” guidelines and “general (not procedure‐specific) enhanced recovery items.” In this review, we focused on the procedure‐specific guidelines and tried to update the contents of every element of the procedure‐specific guidelines. The procedure‐specific guidelines consist of the following eight elements: “Preoperative nutrition,” “Preoperative oral pharmaconutrition,” “Access (of gastrectomy),” “Wound catheters and transversus abdominis plane block,” “Nasogastric/Nasojejunal decompression,” “Perianastomotic drains,” “Early postoperative diet and artificial nutrition,” and “Audit.” On reviewing papers supporting these elements, it was reconfirmed that the recommendations of the guidelines are pertinent and valid. Four meta‐analyses concerning the evaluation of ERAS protocols for gastric cancer were included in this review. Every study showed that the ERAS protocol reduced the cost and duration of hospital stay without increasing surgical complication rates, suggesting that ERAS is effective for gastric cancer surgery. However, it cannot be said that ERAS has achieved full penetration in Japan because most evidence is established in Western countries. Future studies must focus on developing a new ERAS protocols appropriate to Japanese conditions of gastric cancer.

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Section: Consensus Guidelines For Enhanced Recovery After Gastrectomysupporting

confidence: 53%

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Yamagata

Yoshikawa

Yura

et al. 2019

Annals of Gastroent Surgery

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“…One commonly used parameter is the time to first flatus. Varied results were reported regarding whether NGT shortens the time to first flatus [18]. Our data, in accordance with the meta-analyses [3,19] and the prospective randomized controlled trial [10], showed no effect in this regard.…”

Section: Discussionsupporting

confidence: 80%

Clinical Safety and Efficacy of Nasogastric Tube placement after Gastrectomy

Wu¹,

Wang²,

Shi³

et al. 2019

Preprint

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Background: Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery. The aim of this study is to investigate factors influencing the decision-making of nasogastric tube (NGT) placement and its safety and efficacy in clinical practice. Methods: We analyzed our prospectively maintained database including 287 patients underwent elective gastrectomy in our department from January 1 to December 31, 2017. All cases were divided into two groups, namely, the non-nasogastric tube group and the nasogastric tube group. Logistic regression was used to analyze the factors that affect the decision of nasogastric tube placement, and propensity score matching (PSM) was later applied to balance those factors for the analysis of the safety outcomes between the groups. Results: Multivariate analysis showed that resection range (p=0.004, proximal gastrectomy: OR=4.555, 95%CI=1.392-14.905, p=0.016; total gastrectomy: OR=1.990, 95%CI=1.205-3.287, p=0.009) was the only independent risk factors of nasogastric tube placement. NGT was omitted in the majority (58.8%) of distal gastrectomy, but only in 42.5% and 25% in total and proximal gastrectomy. After PSM, we found no significant differences between patients with or without NGT in postoperative hospital stay, time to first flatus and defecation, time to fluid and semi-fluid diet, rate of reinsertion, or hospitalization expenditure (p>0.05 respectively). The incidence of postoperative complications in the two groups were 21.7% and 23.5% respectively (p=0.753), and the incidence of major complications were 7.0% and 9.6% (p=0.472). Conclusions: The decision-making of NGT placement is mainly influenced by the resection range. Omitting NGT is a safe approach in all types of gastrectomy but was not able to enhance the recovery in our practice.

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“…Although oral feeding at POD1 was linked to mortality on univariate analysis, our small sample size prevented any definitive conclusions. Indeed, the gastric tube is no longer used postoperatively in scheduled surgery as the tube itself can provoke adverse events 6,9‐11 …”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the gastric tube is no longer used postoperatively in scheduled surgery as the tube itself can provoke adverse events. 6,[9][10][11]…”

Section: Prevention Of Poapmentioning

confidence: 99%

Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification

Garnier

Mokart

Ewald

et al. 2021

Health Science Reports

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Naso-gastric or naso-jejunal decompression after partial distal gastrectomy for gastric cancer. Final results of a multicenter prospective randomized trial

Cited by 19 publications

References 17 publications

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Clinical Safety and Efficacy of Nasogastric Tube placement after Gastrectomy

Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification

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