Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer

Abstract

Background: Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach.

Methods: A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion.

Results: In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011).

Conclusions: This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

Keywords: Cancer; Feeding; Jejunostomy; Laparoscopic; Oesophagogastric.

Fig. 1

Laparoscopic Jejunostomy technique. A Two jejunal sutures inserted in ‘W’ configuration leaving an approximately 1 cm² box target as shown in red in schematic representation (B). C Endo Close™ device introduced via a 2–3 mm skin incision for retrieval of suture ends. D peritoneal entry must be judged to ensure creation of a 1 cm² box configuration which mirrors that at the jejunum. E Jejunostomy insertion trocar targeted at centre of jejunal box target. F Jejunostomy tube delivered via trocar, with visual confirmation of placement towards distal limb, and saline flush of tube for confirmation of patency and positioning. G Antirotation suture placed at nearby distal jejunal limb