The impact of jejunostomy feeding on nutritional outcomes after oesophagectomy

Abstract

Background

Nutritional status is compromised long‐term following oesophagectomy. Controversy surrounds the optimal route for nutrition support postoperatively and there is wide variation in the use of feeding jejunostomy tubes.

Methods

A retrospective service evaluation was conducted for all consecutive adults who underwent oesophagectomy for a cancer diagnosis within a specialist centre between April 2016 and July 2019 ( n = 165). Nutritional and clinical outcomes were compared for patients who received jejunostomy feeding ( n = 24), versus those who did not ( n = 141).

Results

Patients with feeding jejunostomy lost significantly less weight at both 6 and 12 months postoperatively compared to those without jejunostomy ( p ≤ 0.001 and p = 0.001, respectively). This remained statistically significant in multiple regression, controlling for age, gender, preoperative tumour staging and adjuvant treatment ( p ≤ 0.001 and p = 0.03, respectively). Median length of home enteral feeding was 10 weeks after discharge in the jejunostomy group. We observed minor jejunostomy tube‐related complications in four patients (16.7%). Of those readmitted within 90 days of surgery in the non‐jejunostomy group, nutritional failure was a factor in 43.2% of these readmissions. “Rescue tube feeding” was required by 8.5% of the non‐jejunostomy group within the first postoperative year, including 6.4% within 90 days of surgery.

Conclusions

Use of short‐term supplementary jejunal feeding in addition to oral intake after hospital discharge is beneficial for maintaining weight after oesophagectomy. We suggest a future randomised‐controlled trial to confirm these findings.

Key points

• Malnutrition is prevalent in patients diagnosed with oesophageal cancer and nutritional status is further compromised following oesophagectomy. There is currently nationwide variation in the use of feeding jejunostomy tubes after oesophagectomy.

• This study compared clinical and nutritional outcomes to 12 months postoperatively in a cohort of patients who received feeding jejunostomy tubes ( n = 24) with those who did not ( n = 141).

• Patients with feeding jejunostomy lost significantly less weight at both 6 and 12 months postoperatively compared to those without jejunostomy ( p ≤ 0.001 and p = 0.001, respectively).

• We suggest a future randomised‐controlled trial to confirm our finding that feeding jejunostomy was beneficial for maintaining weight after oesophagectomy, in addition to evaluating its effect on quality of life and body composition.