[Use of a nasojejunal tube after total gastrectomy: a multicentre prospective randomised trial]

Abstract

Dehiscence of the Roux-en-Y oesophagojejunostomy after total gastrectomy is an infrequent complication that may lead to severe morbidity and even death when it occurs. A prospective multicentre randomised trial was designed to assess the need for routine nasojejunal decompression after total gastrectomy with Roux-en-Y oesophagojejunostomy in patients with gastric cancer. Two hundred and thirty-seven patients undergoing total gastrectomy for gastric cancer were randomly assigned to placement of a nasojejunal tube (NJT group) or not (no-NJT group). The patients were monitored for postoperative complications, mortality and postoperative course. The rates of anastomotic leaks were similar in both groups (NJT group, 6.9%; no-NJT group 5.8%) as were the rates of major postoperative complications (25.9% and 21.5%, respectively) and the overall postoperative mortality rates (0.9% and 0.8%, respectively). There were no differences between the two groups in mean time +/- SD to passage of flatus (4.6 +/- 1.3 and 4.5 +/- 1.7 days, respectively) and to starting a liquid diet (7.8 +/- 2.6 and 7.7 +/- 1.6 days, respectively), or in mean +/- SD postoperative hospital stay (13.5 +/- 7.3 and 13.9 +/- 10.9 days, respectively), mean postoperative pain and postoperative abdominal distension. The results of this study suggest that routine placement of an NJT after Roux-en-Y oesophagojejunostomy is unnecessary in elective total gastrectomy for gastric cancer.