An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma12. Issue 7 (28th February 2013)

• Record Type: Journal Article
• Authors: Patel, Sameer H.; Kooby, David A.; Staley, Charles A.; Maithel, Shishir K.
• Is Part Of: Journal of surgical oncology. Volume 107:Issue 7(2013:Jun. 01)
• Page Start: 728
• Page End: 734
• Publication Date: 2013-02-28
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.23324
• Languages: English
• ISSNs: 0022-4790

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Background</title> <p>Feeding jejunostomy tubes (J‐tube) are often placed during gastrectomy for cancer to decrease malnutrition and promote delivery of adjuvant therapy. We hypothesized that J‐tubes actually are associated with increased complications and do not improve nutritional status nor increase rates of adjuvant therapy.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Methods</title> <p>One hundred thirty‐two patients were identified from a prospectively maintained database that underwent gastric resection for gastric adenocarcinoma between 1/00 and 3/11 at one institution. Pre‐ and postoperative nutritional status and relevant intraoperative and postoperative parameters were examined.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>Median age was 64 years (range 23–85). Forty‐six (35%) underwent a total and 86 (65%) a subtotal gastrectomy. J‐tubes were placed in 66 (50%) patients, 34 of whom underwent a subtotal and 32 a total gastrectomy. Preoperative nutritional status was similar between J‐tube and no J‐tube groups as measured by serum albumin (3.5 vs. 3.4 g/dL). Tumor grade, T, N, and overall stage were similar between groups. J‐tube placement was associated with increased postop complications (59% vs. 41%, <italic>P</italic> = 0.04) and infectious complications (36% vs. 17%, <italic>P</italic> = 0.01), of which majority were surgical site infections. J‐tubes were associated with prolonged length of stay (13 vs. 11 days; <italic>P</italic> = 0.05). There was no difference in postoperative nutritional status as measured by 30, 60, and 90‐day albumin levels and the rate of receiving adjuvant therapy was similar between groups (J‐tube: 61%, no J‐tube: 53%, <italic>P</italic> = 0.38). Multivariate analyses revealed J‐tubes to be associated with increased postop complications (HR: 4.8; 95% CI: 1.3–17.7; <italic>P</italic> = 0.02), even when accounting for tumor stage and operative difficulty and extent. Subset analysis revealed J‐tubes to have less associated morbidity after total gastrectomy.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusion</title> <p>J‐tube placement after gastrectomy for gastric cancer may be associated with increased postoperative complications with no demonstrable advantage in receiving adjuvant therapy. Routine use of J‐tubes after subtotal gastrectomy may not be justified, but may be selectively indicated in patients undergoing total gastrectomy. A prospective trial is needed to validate these results. J. Surg. Oncol. 2013;107:728–734. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>