Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?-a systematic review and meta-analysis

Abstract

Background: Malnutrition dramatically increases the risk of postoperative complications and delays patient recovery. Therefore, a feeding jejunostomy tube (FJT) is routinely placed during esophagectomy to maintain the postoperative nutrition supply. However, recently published studies have questioned the need of a FJT in every esophageal cancer patient. Because most patients can resume oral intake shortly after surgery, the nutrition-providing function of a FJT becomes much less critical. In contrast, FJT-related complications could be severe.

Methods: Relevant publications were found out by systemic searching of four medical databases (PubMed, EMBASE, Medline, and Cochrane Center Register of Controlled Trials). By reading the titles and the abstracts, potentially relevant studies were screened from the search results. The incidence of postoperative complications and FJT-related complications were calculated and compared to evaluate the efficacy of a FJT.

Results: Eighteen studies were included in the meta-analysis. The no-FJT group had a similar or even lower incidence of postoperative complications [anastomotic leakage (AL), pulmonary complications, and wound infections] compared with the FJT group. Ileus and FJT site infections were the most common FJT-related complications. The incidence of ileus was approximately 6% (95% CI: 3-12%), and over 63% of the patients with an ileus required re-operation to relieve the obstruction. The pooled mean rate of FJT site infections was 7% (95% CI: 6-9%). Approximately 7% of patients had dysfunction (obstruction or dislocation) of the jejunostomy tube (95% CI: 3-14%).

Conclusions: The non-selective placement of a FJT during esophagectomy provides few benefits to the patients and may even increase the risk of postoperative complications. Therefore, an intraoperative FJT should be selectively prescribed, but not routinely in the surgical treatment of esophageal cancer.

Keywords: Esophagectomy; enteral nutrition; jejunostomy; meta-analysis.