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Davies SJ, Wheelwright S. The impact of jejunostomy feeding on nutritional outcomes after oesophagectomy. J Hum Nutr Diet 2024; 37:126-136. [PMID: 37789732 DOI: 10.1111/jhn.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
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.
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Affiliation(s)
- Sarah J Davies
- School of Health Sciences, Southampton, UK
- Department of Nutrition & Dietetics, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- Department of Dietitics/SLT, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Sally Wheelwright
- School of Health Sciences, Southampton, UK
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Ramakrishnan P, Saini S, Arora A, Khurana G. Impact of Enhanced Recovery Protocols on Short-Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India. World J Surg 2023; 47:2968-2976. [PMID: 37853286 DOI: 10.1007/s00268-023-07204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Surgery for esophageal cancer is associated with high mortality and morbidity, especially in low and middle-income countries. The recent enhanced recovery after surgery guidelines for esophagectomy (2018) which attempt to reduce complications and length of stay (LOS) have rarely been validated in these settings. This study aimed to analyse the effect of this protocol on short-term outcomes in our subset of patients. METHODS A retrospective review was conducted to investigate the outcomes of enhanced recovery protocol (ERP) compared to standard pre-protocol care (PP) in patients who underwent esophagectomy for cancer (31 in ERP vs 61 in PP group) at Cancer Research Institute, Uttarakhand, India. The main outcomes measured were 30-day mortality, morbidity and LOS. Risk assessment was stratified as per Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) systems while complications were classified as per the Clavien-Dindo scale. RESULTS Preoperative clinical characteristics were similar between groups. Though the predicted POSSUM mortality and morbidity were significantly higher in the ERP group (p = 0.007), 30-day morbidity (19.35% vs 42.62%, p = 0.027) as well as median LOS (12 vs 15 days, p < 0.001) was significantly lower in ERP group. The PP group reported 4 deaths within 30 days as compared to none in the ERP group (p = 0.296). Furthermore, the ERP group reported lower occurrence of pulmonary complications (6.4%vs24.6%,p = 0.046), hemodynamic instability (0%vs14.75%,p = 0.026) as well as need for prolonged postoperative ventilation (> 24 h; 0% vs 11.48%, p = 0.004). Both minor and major complications as assessed by the Clavien-Dindo scale were lower in the group ERP though these differences were not statistically significant (0.059). CONCLUSIONS Implementation of ERP improved short-term outcomes; hence can be strongly recommended in patients undergoing esophagectomy.
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Affiliation(s)
- Priya Ramakrishnan
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, 248140, India.
| | - Sunil Saini
- Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, 248140, India
| | - Anshika Arora
- Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, 248140, India
| | - Gurjeet Khurana
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, 248140, India
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Peters AK, Juratli MA, Roy D, Merten J, Fortmann L, Pascher A, Hoelzen JP. Factors Influencing Postoperative Complications Following Minimally Invasive Ivor Lewis Esophagectomy: A Retrospective Cohort Study. J Clin Med 2023; 12:5688. [PMID: 37685756 PMCID: PMC10488704 DOI: 10.3390/jcm12175688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Complications arising following minimally invasive Ivor Lewis esophagectomy often result from inadequate enteral nutrition, highlighting the need for proactive measures to prevent such issues. One approach involves identifying high-risk cases prone to complications and implementing percutaneous endoscopic jejunostomy (PEJ) tube placement during esophageal resection to ensure timely enteral nutrition. METHODS In this single-center, retrospective cohort study, we examined patients who underwent minimally invasive esophagectomy for esophageal cancer at a high-volume center. The dataset encompassed demographic information, comorbidities, laboratory parameters, and intraoperative details. Our center utilized the EndoVac system pre-emptively to safeguard the anastomosis from harmful secretions and to enhance local oxygen partial pressure. All patients received pre-emptive EndoVac therapy and underwent esophagogastroduodenoscopy in the early postoperative days. The need for multiple postoperative EndoVac cycles indicated complications, including anastomotic insufficiency and subsequent requirement for a PEJ. The primary objectives were identifying predictive factors for anastomotic insufficiency and the need for multi-cycle EndoVac therapy, quantifying their effects, and assessing the likelihood of postoperative complications. RESULTS 149 patients who underwent minimally invasive or hybrid Ivor Lewis esophagectomy were analyzed and 21 perioperative and demographic features were evaluated. Postoperative complications were associated with the body mass index (BMI) category, the use of blood pressure medication, and surgery duration. Anastomotic insufficiency as a specific complication was correlated with BMI and the Charlson comorbidity index. The odds ratio of being in the high-risk group significantly increased with higher BMI (OR = 1.074, p = 0.048) and longer surgery duration (OR = 1.005, p = 0.004). CONCLUSIONS Based on our findings, high BMI and longer surgery duration are potential risk factors for postoperative complications following minimally invasive esophagectomy. Identifying such factors can aid in pre-emptively addressing nutritional challenges and reducing the incidence of complications in high-risk patients.
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Affiliation(s)
- Antje K. Peters
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, 48149 Muenster, Germany
| | - Mazen A. Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Dhruvajyoti Roy
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer Merten
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Lukas Fortmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
| | - Jens Peter Hoelzen
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany; (A.K.P.); (M.A.J.)
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Hospital Variation in Feeding Jejunostomy Policy for Minimally Invasive Esophagectomy: A Nationwide Cohort Study. Nutrients 2022; 15:nu15010154. [PMID: 36615812 PMCID: PMC9823823 DOI: 10.3390/nu15010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to investigate hospital variation in the placement, surgical techniques, and safety of feeding jejunostomies (FJ) during minimally invasive esophagectomy (MIE) in the Netherlands. This nationwide cohort study analyzed patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) that underwent MIE for cancer. Hospital variation in FJ placement rates were investigated using case-mix corrected funnel plots. Short-term outcomes were compared between patients with and without FJ using multilevel multivariable logistic regression analysis. The incidence of FJ-related complications was described and compared between hospitals performing routine and non-routine placement (≥90%−<90% of patients). Between 2018−2020, an FJ was placed in 1481/1811 (81.8%) patients. Rates ranged from 11−100% among hospitals. More patients were discharged within 10 days (median hospital stay) without FJ compared to patients with FJ (64.5% vs. 50.4%; OR: 0.62, 95% CI: 0.42−0.90). FJ-related complications occurred in 45 (3%) patients, of whom 23 (1.6%) experienced severe complications (≥Clavien−Dindo IIIa). The FJ-related complication rate was 13.7% in hospitals not routinely placing FJs vs. 1.7% in hospitals performing routine FJ placement (p < 0.001). Significant hospital variation in the use of FJs after MIE exists in the Netherlands. No effect of FJs on complications was observed. FJs can be placed safely, with lower FJ-related complication rates, in centers performing routine placement.
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Duff AM, Lambe G, Donlon NE, Donohoe CL, Brady AM, Reynolds JV. Interventions targeting postoperative pulmonary complications (PPCs) in patients undergoing esophageal cancer surgery: a systematic review of randomized clinical trials and narrative discussion. Dis Esophagus 2022; 35:6565163. [PMID: 35393612 DOI: 10.1093/dote/doac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/06/2022] [Indexed: 12/11/2022]
Abstract
Postoperative pulmonary complications (PPCs) represent the most common complications after esophageal cancer surgery. The lack of a uniform reporting nomenclature and a severity classification has hampered consistency of research in this area, including the study of interventions targeting prevention and treatment of PPCs. This systematic review focused on RCTs of clinical interventions used to minimize the impact of PPCs. Searches were conducted up to 08/02/2021 on MEDLINE (OVID), CINAHL, Embase, Web of Science, and the COCHRANE library for RCTs and reported in accordance with PRISMA guidelines. A total of 339 citations, with a pooled dataset of 1,369 patients and 14 RCTs, were included. Heterogeneity of study design and outcomes prevented meta-analysis. PPCs are multi-faceted and not fully understood with respect to etiology. The review highlights the paucity of high-quality evidence for best practice in the management of PPCs. Further research in the area of intraoperative interventions and early postoperative ERAS standards is required. A consistent uniform for definition of pneumonia after esophagectomy and the development of a severity scale appears warranted to inform further RCTs and guidelines.
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Affiliation(s)
- Ann-Marie Duff
- National Esophageal and Gastric Centre, St James's Hospital Dublin 8 and Trinity St. James's Cancer Institute, Dublin, Ireland.,Trinity Centre for Practice & Health Care Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Gerard Lambe
- Department of Radiology, St. James's Hospital, Dublin 8 & University College Dublin, Dublin, Ireland
| | - Noel E Donlon
- National Esophageal and Gastric Centre, St James's Hospital Dublin 8 and Trinity St. James's Cancer Institute, Dublin, Ireland
| | - Claire L Donohoe
- National Esophageal and Gastric Centre, St James's Hospital Dublin 8 and Trinity St. James's Cancer Institute, Dublin, Ireland
| | - Anne-Marie Brady
- Trinity Centre for Practice & Health Care Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - John V Reynolds
- National Esophageal and Gastric Centre, St James's Hospital Dublin 8 and Trinity St. James's Cancer Institute, Dublin, Ireland
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Kim MS, Shin S, Kim HK, Choi YS, Zo JI, Shim YM, Cho JH. Role of intraoperative feeding jejunostomy in esophageal cancer surgery. J Cardiothorac Surg 2022; 17:191. [PMID: 35987831 PMCID: PMC9392926 DOI: 10.1186/s13019-022-01944-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/15/2022] [Indexed: 12/25/2022] Open
Abstract
Background Feeding jejunostomy was routinely placed during esophagectomy to ensure postoperative enteral feeding. Improved anastomosis technique and early oral feeding strategy after esophagectomy has led to question the need for the routine placement of feeding jejunostomy. The aim of this study is to evaluate role of feeding jejunostomy during Ivor Lewis operation.
Methods We retrospectively reviewed 414 patients who underwent the Ivor Lewis operations from January 2015 to December 2018. Results 61 patients (14.7%) received jejunostomy insertion. The most common indication for jejunostomy was neoadjuvant concurrent chemoradiation therapy (CCRT). 48 patients (79%) had jejunostomy removed within 60 days after the surgery and the longest duration of jejunostomy inserted state was 121 days. About two-third of the patients with jejunostomy had never prescribed with an enteral feeding product. Among 353 patients without intraoperative feeding jejunostomy, 11(3.1%) received delayed jejunostomy insertion. Graft-related problems (6 patients), cancer progression (3 patients), acute lung injury (1 patient), and swallowing difficulty (1 patient) were reasons for delayed feeding jejunostomy insertion. Complication rate was relatively high as 24 patients (33.3%) out of 72 patients with jejunostomy insertion had complications and 7 patients (9.7%) visited ER more than twice with jejunostomy-related complications. Conclusion Only 3.6% patients who underwent the Ivor Lewis operation during 4-year span had anastomosis leakage. Although one-third of the patients with jejunostomy were benefited with alternative method of feeding after discharge, high complication rate regarding jejunostomy should be also considered. We believe feeding jejunostomy should not be applied routinely with prophylactic measures and should be reserved to very carefully selected patients with multiple high-risk factors.
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Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy. Nutrients 2021; 13:nu13103616. [PMID: 34684617 PMCID: PMC8539606 DOI: 10.3390/nu13103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
Recently, it has been shown that directly starting oral feeding (DOF) from postoperative day one (POD1) after a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) can further improve postoperative outcomes. However, in some patients, tube feeding by a preemptively placed jejunostomy is necessary. This single-center cohort study investigated risk factors associated with failure of DOF in patients that underwent a MIE-IL between October 2015 and April 2021. A total of 165 patients underwent a MIE-IL, in which DOF was implemented in the enhanced recovery after surgery program. Of these, 70.3% (n = 116) successfully followed the nutritional protocol. In patients in which tube feeding was needed (29.7%; n = 49), female sex (compared to male) (OR 3.5 (95% CI 1.5–8.1)) and higher ASA scores (III + IV versus II) (OR 2.2 (95% CI 1.0–4.8)) were independently associated with failure of DOF for any cause. In case of failure, this was either due to a postoperative complication (n = 31, 18.8%) or insufficient caloric intake on POD5 (n = 18, 10.9%). In the subgroup of patients with complications, higher ASA scores (OR 2.8 (95% CI 1.2–6.8)) and histological subtypes (squamous-cell carcinoma versus adenocarcinoma and undifferentiated) (OR 5.2 (95% CI 1.8–15.1)) were identified as independent risk factors. In the subgroup of patients with insufficient caloric intake, female sex was identified as a risk factor (OR 5.8 (95% CI 2.0–16.8)). Jejunostomy-related complications occurred in 17 patients (10.3%). In patients with preoperative risk factors, preemptively placing a jejunostomy may be considered to ensure that nutritional goals are met.
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Johnson S, Ziegler J, August DA. Timing of oral intake after esophagectomy: A narrative review of the literature and case report. Nutr Clin Pract 2021; 37:536-554. [PMID: 34608676 DOI: 10.1002/ncp.10777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Esophagectomy, a treatment modality for esophageal cancer, is associated with high rates of morbidity, the most common being anastomotic leaks and pulmonary complications. The current standard of care for nutrition support after esophagectomy includes a period of nothing by mouth with enteral nutrition support via jejunostomy tube owing to the concern of increasing the risk of anastomotic leak as a result of early postoperative oral intake. However, the optimal timing of oral diet initiation remains controversial. This narrative review presents a patient who incurred an anastomotic leak following esophagectomy after initiation of oral intake on postoperative day 5 and evaluates the current literature on the timing of oral diet initiation after esophagectomy. A systematic literature search was performed to assess current evidence evaluating early oral diet (EOD) initiation after esophagectomy. Over the past 5 years, 11 studies have evaluated the impact of EOD initiation after esophagectomy in comparison with a conventional feeding regimen, including a period of nothing by mouth with enteral or parenteral nutrition support. The available evidence suggests that EOD initiation does not increase rates of complications after esophagectomy. However, the evidence is limited by the lack of a standardized definition of what constitutes EOD initiation, patient selection bias, variations in nutrition support provided in the studies, and lack of statistical analyses evaluating the impact of potential confounding variables. Additional research with larger, high-quality randomized controlled trials is needed to determine the optimal timing of diet initiation after esophagectomy.
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Affiliation(s)
- Stephani Johnson
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - David A August
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA.,Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Huang C, Liang X, Du S, He J, Bai Q, Feng X, Liu X, Tian X, Wang J. Therapeutic Effect and Cost-Benefit Analysis of Three Different Nutritional Schemes for Esophageal Cancer Patients in the Early Post-operative Period. Front Nutr 2021; 8:651596. [PMID: 34222299 PMCID: PMC8247476 DOI: 10.3389/fnut.2021.651596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/18/2021] [Indexed: 12/09/2022] Open
Abstract
Objective: To retrospectively investigate the comparative efficacy, safety and cost-benefits of three nutritional treatment schemes including short peptide jejunal nutrition (SPJN), whole protein jejunal nutrition (WPJN), and partial parenteral nutrition (PPN) in patients underwent esophagectomy for esophageal cancer in our hospital. This study was carried out in accordance with the conceptual framework of nutritional therapy in fast-track rehabilitation surgery. Methods: We retrospectively reviewed 305 patients who were assigned to receive esophagectomy for esophageal cancer. Eligible patients was naturally divided into SPJN group [n = 98 (32.1%)], WPJN group [n = 95 (31.1%)], and PPN group [n = 112 (36.7%)] according to the type of nutritional scheme which was actually prescribed to patients by the attendingphysician in clinical practice. The differences of the serum total protein (TP), albumin (ALB), pre-albumin (PA), hemoglobin (HGB), white blood cells (WBCs), red blood cells (RBCs) and neutrophils were compared among 3 nutritional schemes groups. We also investigated the relationship of the fluid intake, urine output, gastric juice drainage volume and thoracic drainage volume among 3 nutritional groups at 3 days after surgery. Moreover, the differences of cost-benefit indexes, complications, length of hospitalization and hospital expenditure were also compared. Results: The serum TP, ALB, and PA in the SPJN group were all higher than those in the WPJN and PPN groups (p < 0.05). The gastric juice volume of gastrointestinal decompression drainage and fluid volume of thoracic drainage in the SPJN group were all less than that in the WPJN group (p < 0.05). The overall hospital stay and post-operative hospital stay in the SPJN group were all shorter than that in WPJN group (p < 0.05). Moreover, the incidence of post-operative complications including anastomotic leakage, infection, and gastrointestinal reaction was remarkably lower in the SPJN group compared to the WPJN group (p < 0.05). Interesting, hospital expenditure in the PPN group was less than that in the SPJN and the WPJN groups (p < 0.001). Conclusion: Patients may obtain benefits in improving protein level after receiving SPJN scheme at the early stage after esophagectomy. Meanwhile, patients may obtain benefits in improving post-operative complications and hospital stay after receiving SPJN or PPN compared to WPJN protocol. However, the difference between SPJN and PPN requires further study because no difference was detected in terms of clinical outcomes including complications and the length of hospitalization although PPN may achieve a possible decrease of medical expenditure.
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Affiliation(s)
- Chen Huang
- Department of Nutrition, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xinyu Liang
- Department of Nutrition, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Shanshan Du
- Department of Nutrition, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Jie He
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Bai
- Department of Nutrition, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xiaoqing Feng
- Department of Nutrition, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xiaoqing Liu
- Department of Thoracic Surgery, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xu Tian
- Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain.,Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Wang
- Department of Nutrition, Xinqiao Hospital of Army Medical University, Chongqing, China
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Li HN, Chen Y, Dai L, Wang YY, Chen MW, Mei LX. A Meta-analysis of Jejunostomy Versus Nasoenteral Tube for Enteral Nutrition Following Esophagectomy. J Surg Res 2021; 264:553-561. [PMID: 33864963 DOI: 10.1016/j.jss.2021.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/21/2021] [Accepted: 02/27/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Postoperative nutritional therapy is of paramount importance for patients undergoing esophagectomy. The jejunostomy and nasoenteral tube are the popular routes for nutritional therapy. However, which one is the preferred route is unclear. This study aims to analyze the differences in safety and efficacy of the two routes for nutritional therapy. MATERIALS AND METHODS PubMed, Web of Science, Cochrane Library, and EMBASE (till September 17, 2020) were searched. The primary outcome was postoperative pneumonia. Secondary outcomes were the length of hospital stays (LOS), bowel obstruction, catheter dislocation, anastomotic leakage, overall postoperative complications, and postoperative albumin. Weighted mean differences (WMD) and odds ratios (OR) were calculated for statistical analysis. RESULTS Ten studies involving a total of 1,531 patients in the jejunostomy group and 1,375 patients in the nasoenteral tube group were included. Compared with patients in the nasoenteral tube group, those in the jejunostomy group had a lower incidence of postoperative pneumonia (OR = 0.68, P < 0.001), shorter LOS (WMD = -0.85, P < 0.001), and lower risk of catheter dislocation (OR = 0.15, P = 0.001). There were no significant differences in the incidence of anastomotic leakage (OR = 0.84, P = 0.43), overall postoperative complications (OR = 0.87, P = 0.59), and postoperative albumin (WMD = -0.40, P = 0.24). However, patients in the jejunostomy group had a higher risk of bowel obstruction (OR = 8.42, P = 0.002). CONCLUSIONS Jejunostomy for enteral nutrition showed superior outcomes in terms of postoperative pneumonia, LOS, and catheter dislocation. Jejunostomy may be the preferred enteral nutritional route following esophagectomy.
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Affiliation(s)
- Huan-Ni Li
- Department of Gynaecology and Obstetrics, Changsha Central Hospital, University of South China, Changsha 410004, China
| | - Yong Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Lei Dai
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yong-Yong Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Ming-Wu Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Li-Xiang Mei
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
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11
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Holmén A, Hayami M, Szabo E, Rouvelas I, Agustsson T, Klevebro F. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg 2020; 406:1415-1423. [PMID: 33230577 PMCID: PMC8370925 DOI: 10.1007/s00423-020-02037-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/17/2020] [Indexed: 01/13/2023]
Abstract
Purpose Insertion of a nutritional jejunostomy in conjunction with esophagectomy is performed with the intention to decrease the risk for postoperative malnutrition and improve recovery without adding significant catheter-related complications. However, previous research has shown no clear benefit and there is currently no consensus of practice. Methods All patients treated with esophagectomy due to cancer during the period 2006–2017 reported in the Swedish National Register for Esophageal and Gastric Cancer were included in this register-based cohort study from a national database. Patients were stratified into two groups: esophagectomy alone and esophagectomy with jejunostomy. Results A total of 847 patients (45.27%) had no jejunostomy inserted while 1024 patients (54.73%) were treated with jejunostomy. The groups were comparable, but some differences were seen in histological tumor type and tumor stage between the groups. No significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate were seen. There was no evidence of increased risk for significant jejunostomy-related complications. Patients in the jejunostomy group with anastomotic leaks had a statistically significant lower risk for severe morbidity defined as Clavien-Dindo score ≥ IIIb (adjusted odds ratio 0.19, 95% CI: 0.04–0.94, P = 0.041) compared to patients with anastomotic leaks and no jejunostomy. Conclusion A nutritional jejunostomy is a safe method for early postoperative enteral nutrition which might decrease the risk for severe outcomes in patients with anastomotic leaks. Nutritional jejunostomy should be considered for patients undergoing curative intended surgery for esophageal and gastro-esophageal junction cancer.
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Affiliation(s)
- Anders Holmén
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. .,Department of Surgery, Södersjukhuset, Stockholm, Sweden.
| | - Masaru Hayami
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Szabo
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ioannis Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Thorhallur Agustsson
- Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet
- Södersjukhuset, Stockholm, Sweden
| | - Fredrik Klevebro
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
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12
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Kroese TE, Tapias L, Olive JK, Trager LE, Morse CR. Routine intraoperative jejunostomy placement and minimally invasive oesophagectomy: an unnecessary step?†. Eur J Cardiothorac Surg 2020; 56:746-753. [PMID: 30907417 DOI: 10.1093/ejcts/ezz063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Adequate nutrition is challenging after oesophagectomy. A jejunostomy is commonly placed during oesophagectomy for nutritional support. However, some patients develop jejunostomy-related complications and the benefit over oral nutrition alone is unclear. This study aims to assess jejunostomy-related complications and the impact of intraoperative jejunostomy placement on weight loss and perioperative outcomes in patients with oesophageal cancer treated with minimally invasive Ivor Lewis oesophagectomy (MIE). METHODS From a prospectively maintained database, patients were identified who underwent MIE with gastric reconstruction. Between 2007 and 2016, a jejunostomy was routinely placed during MIE. After 2016, a jejunostomy was not utilized. Postoperative feeding was performed according to a standardized protocol and similar for both groups. The primary outcomes were jejunostomy-related complications, relative weight loss at 3 and 6 months postoperative and perioperative outcomes, including anastomotic leak, pneumonia and length of stay, respectively. RESULTS A total of 188 patients were included, of whom 135 patients (72%) received a jejunostomy. Ten patients (7.4%) developed jejunostomy-related complications, of whom 30% developed more than 1 complication. There was no significant difference in weight loss between groups at 3 months (P = 0.73) and 6 months postoperatively (P = 0.68) and in perioperative outcomes (P-value >0.999, P = 0.591 and P = 0.513, respectively). CONCLUSIONS The use of a routine intraoperative jejunostomy appears to be an unnecessary step in patients undergoing MIE. Intraoperative jejunostomy placement is associated with complications without improving weight loss or perioperative outcomes. Its use should be tailored to individual patient characteristics. Early oral nutrition allows patients to maintain an adequate nutritional status.
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Affiliation(s)
- Tiuri E Kroese
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Leonidas Tapias
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jacqueline K Olive
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lena E Trager
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher R Morse
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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13
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Enhanced recovery programs in gastrointestinal surgery: Actions to promote optimal perioperative nutritional and metabolic care. Clin Nutr 2020; 39:2014-2024. [DOI: 10.1016/j.clnu.2019.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
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14
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Feeding protocol deviation after esophagectomy: A retrospective multicenter study. Clin Nutr 2020; 39:1258-1263. [DOI: 10.1016/j.clnu.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/19/2019] [Accepted: 05/16/2019] [Indexed: 12/27/2022]
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15
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Janssen HJ, Fransen LF, Ponten JE, Nieuwenhuijzen GA, Luyer MD. Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer. Nutrients 2020; 12:E778. [PMID: 32183492 PMCID: PMC7146612 DOI: 10.3390/nu12030778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4-7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4-33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.
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Affiliation(s)
| | | | | | | | - Misha D.P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
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16
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Zheng R, Devin CL, Pucci MJ, Berger AC, Rosato EL, Palazzo F. Optimal timing and route of nutritional support after esophagectomy: A review of the literature. World J Gastroenterol 2019; 25:4427-4436. [PMID: 31496622 PMCID: PMC6710171 DOI: 10.3748/wjg.v25.i31.4427] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.
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Affiliation(s)
- Richard Zheng
- Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Courtney L Devin
- Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Michael J Pucci
- Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Adam C Berger
- Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Ernest L Rosato
- Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States
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17
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Klevebro F, Johar A, Lagergren J, Lagergren P. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus 2019; 32:5212877. [PMID: 30496419 DOI: 10.1093/dote/doy113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substantial weight loss and eating problems are common before and after esophagectomy for cancer. The use of jejunostomy might prevent postoperative weight loss, but studies evaluating other outcomes are scarce. This study aims to assess the influence of jejunostomy on postoperative health-related quality of life (HRQOL), complications, reoperation, hospital stay, and survival. This prospective and population-based cohort study included all patients operated on for esophageal or gastroesophageal junction cancer in Sweden in 2001-2005 with follow-up until 31st December 2016. Data regarding patient and tumor characteristics and treatment were prospectively collected. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), whereas Cox regression provided hazard ratios with 95% CI. All risk estimates were adjusted for age, sex, tumor histology, stage, comorbidity, surgical approach, neoadjuvant therapy, and body mass index and weight loss at baseline. Among 397 patients, 181 (46%) received a jejunostomy during surgery. The use of jejunostomy did not influence the HRQOL at 6 months or 3 years after treatment. Jejunostomy users had no statistically significantly increased risk of postoperative complications (OR 1.27; 95% CI 0.86-1.87) or reoperation (OR 1.70; 95% CI 0.88-3.28). Intensive unit care and length of hospital stay was the same independent of the use of jejunostomy. The all-cause mortality was not increased in the jejunostomy group (HR 0.89, 95% CI: 0.74-1.07). This study indicates that jejunostomy does not influence postoperative HRQOL, complications, or survival after esophageal cancer surgery, it can be considered a safe method for early enteral nutrition after esophageal cancer surgery but benefits for the patients need further investigations.
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Affiliation(s)
- F Klevebro
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - P Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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18
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Bouabdallah I, D'Journo XB. Risk factors of post-esophagectomy-induced malnutrition. J Thorac Dis 2019; 11:S1357-S1359. [PMID: 31245132 DOI: 10.21037/jtd.2019.03.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ilies Bouabdallah
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, Marseille, France
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19
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Subramanian M, Kozower BD. Immunonutrition in the esophagectomy patient: food for thought. J Thorac Dis 2019; 11:2218-2221. [PMID: 31372257 DOI: 10.21037/jtd.2019.05.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Melanie Subramanian
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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20
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Abstract
Esophagectomy is the mainstay for treating esophageal cancers and other pathology. Even with refinements in surgical techniques and the introduction of minimally invasive approaches, the overall morbidity remains formidable. Complications, if not quickly recognized, can lead to significant long-term sequelae and even death. Vigilance with a high degree of suspicion remains the surgeon's greatest ally when caring for a patient who has recently undergone an esophagectomy. In this review, we highlight different approaches in dealing with anastomotic leaks, chyle leaks, cardiopulmonary complications, and later functional issues after esophagectomy.
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Affiliation(s)
- Igor Wanko Mboumi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Wisconsin School of Medicine, 600 Highland Avenue K4/752, Madison, WI 53792-7375, USA
| | - Sushanth Reddy
- Department of Surgery, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Anne O Lidor
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Wisconsin School of Medicine, 600 Highland Avenue K4/752, Madison, WI 53792-7375, USA.
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21
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Abstract
Malnutrition is quite common in patients with esophageal cancer, and can be secondary to tumor related dysphagia or treatment side effects. Traditionally, open feeding jejunostomy tube was performed in all patients undergoing surgical treatment of esophageal cancer. With the advent of minimally invasive approaches, placement of the jejunostomy tube can be currently accomplished with either robotic or laparoscopic assistance. Here, we discuss the technical aspects as well as the pros and cons of a minimally invasive jejunostomy feeding tube placement.
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Affiliation(s)
- Charles Bakhos
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Shrey Patel
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Roman Petrov
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA.,Department of Surgical Oncology, Section of Thoracic Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Abbas Abbas
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA.,Department of Surgical Oncology, Section of Thoracic Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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22
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de Vasconcellos Santos FA, Torres Júnior LG, Wainstein AJA, Drummond-Lage AP. Jejunostomy or nasojejunal tube after esophagectomy: a review of the literature. J Thorac Dis 2019; 11:S812-S818. [PMID: 31080663 DOI: 10.21037/jtd.2018.12.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Patients undergoing esophagectomy for cancer are a difficult to treat group of patients. At diagnosis they will present some degree of malnutrition in up to 80% and the causes are from multifactorial origin: the inability of food ingestion, advanced age, taste disturbances, and morbidity related to neoadjuvant treatment. In order to restaure the nutritional status, enteral nutritional support is preferable to parenteral support because of the risks of septic complications associated with venous catheters. During the postoperative period, the oral route is often inaccessible in these patients due to swallowing disorders and eventually mechanical ventilation, and if possible, often it does not provide sufficient caloric amounts for postoperative energy balance. For these reasons, it is usually recommended additional nutritional support. There are few studies in the literature that specifically address which is the most adequate route for enteral nutrition in patients undergoing esophagectomy. Nasojejunal catheters present a higher incidence of local complications, such as displacement and occlusion, whereas jejunostomy is more associated with reinterventions for the treatment of complications secondary to extravasation. Although there is weak evidence in the literature and a lack of randomized, prospective and multicenter studies evaluating the best enteral nutrition route in the postoperative period of esophagectomy, the use of the nasoenteric catheter seems to be adequate due to its simplicity of positioning and low rates of severe complications. In this paper a review is performed of the evidence about this subject.
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Affiliation(s)
- Fernando Augusto de Vasconcellos Santos
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil.,Departmet of Surgery, Hospital Governador Israel Pinheiro, Belo Horizonte, MG, Brazil
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23
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Rubinkiewicz M, Witowski J, Su M, Major P, Pędziwiatr M. Enhanced recovery after surgery (ERAS) programs for esophagectomy. J Thorac Dis 2019; 11:S685-S691. [PMID: 31080645 DOI: 10.21037/jtd.2018.11.56] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A perioperative treatment protocol, enhanced recovery after surgery (ERAS) focuses on accelerating patient recovery. Previous studies confirmed that ERAS decreases surgical trauma and the stress response, which improved outcomes including reduced length of hospital stay (LOS) and decreased postoperative morbidity. While ERAS protocols have been successfully implemented in a variety of surgical disciplines (colorectal, bariatric, orthopedic, and gynecologic surgery), its use in esophageal surgery is still limited. This paper analyzes the feasibility and value of the ERAS protocol for esophageal surgery. Reviewing the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity. The evidence lacks randomized control trials. Further, the ERAS Society published recommendations for esophageal resection. This opportunity for unification of the protocol would make the studies more comparable and leads to stronger conclusions. Surgery specific items also require further confirmation. Nonetheless, the successful introduction of the ERAS protocol into a wide variety of surgical disciplines provides optimism for ERAS's effectiveness in esophageal surgery.
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Affiliation(s)
- Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michael Su
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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24
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Ericson J, Lundell L, Klevebro F, Kamiya S, Nilsson M, Rouvelas I. Long-term weight development after esophagectomy for cancer-comparison between open Ivor-Lewis and minimally invasive surgical approaches. Dis Esophagus 2019; 32:5142515. [PMID: 30351390 DOI: 10.1093/dote/doy075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophagectomy is an extensive procedure with severe postoperative effects. It can be assumed that the greater the trauma, the longer the nutritional recovery. This retrospective observational single-center cohort study compared weight development after esophagectomy with open and minimally invasive techniques. Three groups were compared in this study, one representing the first 41 patients who underwent the minimally invasive McKeown esophagectomy (MIMK). The second group included the first 84 consecutive patients operated with the minimally invasive Ivor-Lewis esophagectomy (MIIL). The third group comprised 100 consecutive patients operated with open thoracoabdominal Ivor-Lewis esophagectomy (IL). Virtually all patients submitted to a minimally invasive esophagectomy (MIE) and the majority with an IL had a jejunal catheter inserted during operation for postoperative enteral feeding. All together 225 patients were included in this study. The mean weight loss during the first year was 13.1% (±4.1), 11.2% (±6.1), and 9.6% (±7.5) in the IL, MIIL, and MIMK group, respectively (P = 0.85 and P = 0.95, respectively). The median duration of postoperative enteral nutrition support varied substantially within the groups and was 23.5 days in the IL group (range: 0-2033 days), 54.5 days in those having an MIIL (range: 0-308 days; P ≤ 0.001) and 57.0 days among patients in the MIMK group (range: 0-538 days; P ≤ 0.022). There was no difference in the risk of losing at least 10% of the preoperative weight at 3 or 6 months postoperatively between the groups. However, in patients who suffered severe complications (Clavien-Dindo score ≥ IIIb) after MIIL, there was a nonsignificant trend toward a lower risk of a 10% or greater weight loss, 3 months postoperatively. In conclusion, the greater surgical trauma associated with the traditional open esophagectomy was not followed by more severe weight loss, or other signs of poorer nutritional recovery, when compared to minimal invasive surgical techniques.
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Affiliation(s)
- J Ericson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Function area Clinical Nutrition
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - F Klevebro
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Kamiya
- Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - I Rouvelas
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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25
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van der Horst S, de Maat MFG, van der Sluis PC, Ruurda JP, van Hillegersberg R. Extended thoracic lymph node dissection in robotic-assisted minimal invasive esophagectomy (RAMIE) for patients with superior mediastinal lymph node metastasis. Ann Cardiothorac Surg 2019; 8:218-225. [PMID: 31032205 DOI: 10.21037/acs.2019.01.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Robot-assisted surgery may have a role in improving oncological outcomes in esophagectomy. Especially in the anatomical areas in the chest that are more difficult to reach in open surgery (including the superior mediastinum). The dexterity of the robotic instruments aid in performing a more extensive nodal dissection and the precision and detailed vision of the robotic system potentially improves staging, oncological outcomes and reduces complications (i.e., recurrent nerve palsy). In this article, we describe our experience and clinical outcomes in patients treated by robot assisted minimal invasive esophagectomy (RAMIE) in cN+ esophageal cancer patients with positive nodes localized in the superior mediastinum. Methods From May 2007-2018, all patients who had involved nodes by either fluor-18-deoxyglucose positron-emission-tomography-computed tomography (FDG-PET-CT) or endoscopic ultrasound (EUS) + fine needle aspiration (FNA) localized in the superior mediastinum (above level Th4/sternal angle) were identified. Patient characteristics, perioperative data, postoperative clinical outcomes/complications and overall survival were prospectively recorded and retrospectively evaluated. Results Forty patients (48% adenocarcinoma) met our inclusion criteria. All patients underwent a three-stage procedure with cervical anastomosis and 90% of the patients underwent neoadjuvant chemoradiotherapy. Mortality occurred in three patients (7.5%), of which two were caused by severe acute respiratory distress syndrome (ARDS). The most frequent complications were pneumonia (25%), chylothorax (20%), anastomotic leakage (17.5%) and vocal cord paralysis (17.5%) which was grade 1 in 72% of the patients. Radicality rate (R0 resection) was 98% and the average lymph node yield was 24 (range, 9-57). Median overall and disease-free survival was 26 and 17 months, respectively. Conclusions RAMIE for esophageal cancer patients with node positive disease in the superior mediastinum is associated with increased mortality/morbidity. Oncological outcome showed excellent lymph node yield, R0 rate and survival was equal compared to patients with lower mediastinal node positive disease.
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Affiliation(s)
- Sylvia van der Horst
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel F G de Maat
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Akiyama Y, Iwaya T, Endo F, Nikai H, Sato K, Baba S, Chiba T, Kimura T, Takahara T, Nitta H, Otsuka K, Mizuno M, Kimura Y, Koeda K, Sasaki A. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis 2018; 10:6854-6862. [PMID: 30746231 DOI: 10.21037/jtd.2018.11.97] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Previous studies have shown that enteral nutrition (EN) helps reduce severe postoperative complications after esophagectomy. However, the incidence of jejunostomy-related complications is approximately 30%. We evaluated the operative outcomes in patients who did not receive EN via feeding jejunostomy after esophagectomy. Methods We retrospectively reviewed 76 consecutive patients with esophageal cancer who received radical esophagectomy. Operative outcomes were compared between 33 patients who received postoperative EN via feeding jejunostomy (group A; from May 2014 to September 2015) and 43 patients who did not receive EN via feeding jejunostomy (group B; from September 2015 to December 2017). Results The American Society of Anesthesiologists performance status score of the patients in group B was significantly higher than that of patients in group A (P=0.002). The postoperative morbidity rate was comparable between the two groups (group A, 30.3% vs. group B, 44.2%, P=0.217). No significant between-group differences were observed in the incidence of infectious complications, postoperative hospital stay, readmission within 30 days after discharge, or pneumonia after discharge within 6 months. The incidence of bowel obstruction was significantly higher in group A than in group B (group A, 9.1% vs. group B, 0%, P=0.044). Two patients in group B required nutritional support via total parenteral nutrition due to bilateral vocal cord palsy or pneumonia. Conclusions Jejunostomy-related bowel obstruction in the patients with feeding jejunostomy was significantly higher than that in the patients without jejunostomy. There was no increase in postoperative complications (including pneumonia) in the patients who did not receive EN via feeding jejunostomy. Our results suggest that routine feeding jejunostomy may not be necessary for all patients undergoing esophagectomy.
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Affiliation(s)
- Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Fumitaka Endo
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Kei Sato
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Shigeaki Baba
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takehiro Chiba
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Toshimoto Kimura
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masaru Mizuno
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yusuke Kimura
- Department of Palliative Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Keisuke Koeda
- Department of Medical Safety Science, Iwate Medical University School of Medicine, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
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27
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Zylstra J, Boshier P, Whyte GP, Low DE, Davies AR. Peri-operative patient optimization for oesophageal cancer surgery - From prehabilitation to enhanced recovery. Best Pract Res Clin Gastroenterol 2018; 36-37:61-73. [PMID: 30551858 DOI: 10.1016/j.bpg.2018.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/19/2018] [Indexed: 02/08/2023]
Affiliation(s)
- J Zylstra
- Department of Gastrointestinal Medicine and Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Sport and Exercise Science, Faculty of Science, Liverpool John Moore's University, Liverpool, UK
| | - P Boshier
- Virginia Mason Medical Centre, Seattle, USA
| | - G P Whyte
- School of Sport and Exercise Science, Faculty of Science, Liverpool John Moore's University, Liverpool, UK; Research Institute for Sport & Exercise Science, Liverpool John Moore's University, UK
| | - D E Low
- Virginia Mason Medical Centre, Seattle, USA
| | - A R Davies
- Department of Gastrointestinal Medicine and Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; Division of Cancer Studies, King's College London, UK.
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28
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Álvarez-Sarrado E, Mingol Navarro F, J Rosellón R, Ballester Pla N, Vaqué Urbaneja FJ, Muniesa Gallardo C, López Rubio M, García-Granero Ximénez E. Feeding Jejunostomy after esophagectomy cannot be routinely recommended. Analysis of nutritional benefits and catheter-related complications. Am J Surg 2018; 217:114-120. [PMID: 30309617 DOI: 10.1016/j.amjsurg.2018.08.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/08/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients undergoing esophagectomy for cancer usually deal with malnourishment which increases postoperative morbimortality. The objective of this paper is to analyze the nutritional benefits of feeding jejunostomy (FJ) for early postoperative enteral nutrition (EN) and directly-related complications. MATERIAL AND METHODS Retrospective study of 100 patients undergoing esophagectomy for cancer between 2008 and 2016. RESULTS FJ was placed in 47 patients. 82.98% reached EN requirements in FJ group, with a median EN re-start of 1.9 days and median days to objective requirements of 5 days. 51.06% developed directly-related FJ complication, 91.66% of them mild ones (gastrointestinal or catheter-related). 2 patients (4.25%) required re-intervention. No significant differences were shown in total protein and albumin seric levels during first postoperative week and in anastomotic leak rate between both groups (p > 0.05). CONCLUSIONS Feeding jejunostomies are associated with a great number of complications although most are not life-threatening. Since its nutritional benefit is not proven FJ cannot routinely recommended after esophagectomy. However, the optimal pathway for EN reintroduction, including direct oral intake, is still a matter of debate.
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Affiliation(s)
- Eduardo Álvarez-Sarrado
- General Surgery Service, University and Polytechnic La Fe Hospital, Av. Fernando Abril, Martorell, 106, 46026, Valencia, Spain.
| | - Fernando Mingol Navarro
- Esophago-gastric Surgery Unit, University and Polytechnic La Fe Hospital, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain.
| | - Raquel J Rosellón
- General Surgery Service, University and Polytechnic La Fe Hospital, Av. Fernando Abril, Martorell, 106, 46026, Valencia, Spain.
| | - Neus Ballester Pla
- General Surgery Service, University and Polytechnic La Fe Hospital, Av. Fernando Abril, Martorell, 106, 46026, Valencia, Spain.
| | - Francisco Javier Vaqué Urbaneja
- Esophago-gastric Surgery Unit, University and Polytechnic La Fe Hospital, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain.
| | - Carmen Muniesa Gallardo
- General Surgery Service, University and Polytechnic La Fe Hospital, Av. Fernando Abril, Martorell, 106, 46026, Valencia, Spain.
| | - María López Rubio
- General Surgery Service, University and Polytechnic La Fe Hospital, Av. Fernando Abril, Martorell, 106, 46026, Valencia, Spain.
| | - Eduardo García-Granero Ximénez
- Head of General Surgery Service, University and Polytechnic La Fe Hospital, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain.
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29
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Xing J, Zhang Z, Ke L, Zhou J, Qin B, Liang H, Chen X, Liu W, Liu Z, Ai Y, Wang D, Wang Q, Zhou Q, Zhang F, Qian K, Jiang D, Zang B, Li Y, Huang X, Qu Y, Xie Y, Xu D, Zou Z, Zheng X, Liu J, Guo F, Liang Y, Sun Q, Gao H, Liu Y, Chang P, Ceng A, Yang R, Yao G, Sun Y, Wang X, Zhang Y, Wen Y, Yu J, Sun R, Li Z, Yuan S, Song Y, Gao P, Liu H, Zhang Z, Wu Y, Ma B, Guo Q, Shan F, Yang M, Li H, Li Y, Lu W, Wang L, Qian C, Wang Z, Lin J, Zhang R, Wan P, Peng Z, Gong Y, Huang L, Wu G, Sun J, Deng Y, Shi D, Zhou L, Zhou F, Shi Q, Guo X, Liu X, Wu W, Meng X, Li L, Chen W, Li S, Wan X, Chao Z, Zhang A, Gu L, Chen W, Wu J, Zhou L, Zhang Z, Weng Y, Feng Y, Yang C, Feng Y, Zhao S, Tong F, Hao D, Han H, Fu B, Gong C, Li Z, Hu K, Kou Q, Zhang H, Liu J, Fan C, Zhou X, Chen X, Sun J, Zhou X, Song B, Sun C, Zhao L, Dong X, Zhang L, Tong D, Pan Z, Cai C, Wang D, Dong Y, Gong Y, Wu Z, Meng X, Wang P, Li W. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care 2018; 22:229. [PMID: 30244686 PMCID: PMC6151932 DOI: 10.1186/s13054-018-2159-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. METHODS This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. RESULTS A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). CONCLUSIONS The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.
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Affiliation(s)
- Juan Xing
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Ke
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Jing Zhou
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Bingyu Qin
- Henan Provincial People’s Hospital, Zhengzhou, China
| | | | | | - Wenming Liu
- Changzhou No.2 People’s Hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Zhongmin Liu
- Jilin University First Hospital, Changchun, China
| | - Yuhang Ai
- Xiangya Hospital Central South University, Changsha, China
| | - Difeng Wang
- Guizhou Medical University affiliated hospital, Guiyang, China
| | | | | | | | - Kejian Qian
- First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongpo Jiang
- Third Military Medical University Daping Hospital, Chongqing, China
| | - Bin Zang
- China Medical University Second Affiliated Hospital, Shenyang, China
| | - Yimin Li
- Guangzhou Medical University First Affiliated Hospital, Guangzhou, China
| | - Xiaobo Huang
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Qu
- Qingdao Municipal Hospital Group, Qingdao, China
| | | | - Donglin Xu
- Guangzhou First Municipal People’s Hospital, Guangzhou, China
| | - Zhiqiang Zou
- Xiehe Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Jianbo Liu
- Inner Mongolia People’s Hospital, Huhehaote, China
| | - Feng Guo
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yafeng Liang
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Qingdao, China
| | - Qiang Sun
- Tianjing People’s Hospital, Tianjin, China
| | - Hongmei Gao
- Tianjing First Central Hospital, Tianjin, China
| | - Yang Liu
- Tangshan Gongren Hospital, Tangshan, China
| | - Ping Chang
- Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Aibin Ceng
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | | | - Gaiqi Yao
- Peking University Third Hospital, Beijing, China
| | - Yun Sun
- Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Xiaorong Wang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, China
| | - Yi Zhang
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Yichao Wen
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Jian Yu
- Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rongqing Sun
- Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Zhiwei Li
- First People’s Hospital of Kunming, Kunming, China
| | - Shiying Yuan
- Union Hospital Affiliated to Tongji Medical College of Huanzhong University of Science and Technology, Wuhan, China
| | - Yunlin Song
- Xinjiang Medical University Affiliated First Hospital, Wulumuqi, China
| | - Peiyang Gao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China
| | - Haiyan Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Yunfu Wu
- Suzhou Municipal Hospital, Suzhou, China
| | - Biao Ma
- Jining Medical College Affiliated Hospital, Jining, China
| | - Qiang Guo
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Shan
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Mingshi Yang
- Central South University Third Xiangya Hospital, Changsha, China
| | - Hailing Li
- 401 Military Hospital of China, Qindao, China
| | - Yuanfei Li
- Changsha Central Hospital, Changsha, China
| | - Weihua Lu
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Lei Wang
- Shanxi Medical University First Affiliated Hospital, Taiyuan, China
| | - Chuangyun Qian
- Kuming Medical University First Affiliated Hospital, Kuming, China
| | - Zhiyong Wang
- Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jiandong Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Peng Wan
- First People’s Hospital of Yichang, Yichang, China
| | - Zhiyong Peng
- Wuhan University Zhongnan Hospital, Wuhan, China
| | - Yuqiang Gong
- Wenzhou Medical University Second Affiliated Hospital, Wenzhou, China
| | - Linxi Huang
- Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Guobao Wu
- Zhongnan University Xiangya Second Hospital, Changsha, China
| | - Jie Sun
- Yunnan Second People’s Hospital, Kunming, China
| | - Yijun Deng
- Yancheng First People’s Hospital, Yancheng, China
| | - Dongwu Shi
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Lixin Zhou
- First People’s Hospital of Foshan, Foshan, China
| | - Fachun Zhou
- Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Qindong Shi
- Xi’an Jiao Tong University First Affiliated Hospital, Xi’an, China
| | | | - Xueyan Liu
- Shenzhen People’s Hospital, Shenzhen, China
| | - Weidong Wu
- Shanxi Dayi Hospital of Shanxi Academy of Medical Science, Taiyuan, China
| | | | - Liandi Li
- Qingdao University Affiliated Hospital, Qingdao, China
| | - Weiwei Chen
- Linhai First People’s Hospital, Linhai, China
| | - Shusheng Li
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xianyao Wan
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - An Zhang
- Chongqing Medical University Second Affiliated Hospital, Chongqing, China
| | - Liming Gu
- People’s Hospital of Yuxi City, Yuxi, China
| | - Wei Chen
- Shijitan Hospital of Capital Medical University, Beijing, China
| | - Jinglan Wu
- Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Lihua Zhou
- Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China
| | | | | | - Yongshun Feng
- Beijing Jingmei Group General Hospital, Beijing, China
| | - Chunli Yang
- Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Yongjian Feng
- Jinan University First Affiliated Hospital, Jinan, China
| | - Sumin Zhao
- General Hospital of Rocket Army, Beijing, China
| | - Fei Tong
- Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China
| | - Dong Hao
- Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Hui Han
- Chinese PLA General Hospital, Beijing, China
| | - Baocai Fu
- Yantai Mountain Hospital, Yantai, China
| | - Chuanyong Gong
- Tianjing Hospital of ITCWM Nankai Hospital, Tianjing, China
| | - Zhiping Li
- Hunan Provincial People’s Hospital, Changsha, China
| | - Kunlin Hu
- People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuye Kou
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Han Zhang
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Jie Liu
- Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Chuming Fan
- First People’s Hospital of Yunnan, Kunming, China
| | - Xin Zhou
- Xinjiang Military General Hospital, Wulumuqi, China
| | | | - Junli Sun
- Luoyang Central Hospital, Luoyang, China
| | - Xuejun Zhou
- Huairou First Hospital of Beijing, Beijing, China
| | - Bin Song
- Military General Hospital of Beijing PLA, Beijing, China
| | - Cheng Sun
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Liyun Zhao
- Guangdong Second TCM Hospital, Guangzhou, China
| | | | | | - Dafei Tong
- Shenyang First People’s Hospital, Shenyang, China
| | - Zhiguo Pan
- Guangzhou Military General Hospital, Guangzhou, China
| | - Chuangjie Cai
- Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | | | | | - Yuanqi Gong
- Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Zhisong Wu
- Beijing University of Chinese Medicine Affiliated Dongfang Hospital, Beijing, China
| | - Xinke Meng
- Shenzhen Second People’s Hospital, Shenzhen, China
| | - Ping Wang
- Chendu Fifth People’s Hospital, Chendu, China
| | - Weiqin Li
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
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30
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Lahoud J, Bazzi K, Yeo D, Carey S. Survey of nutritional practices in total gastrectomy and oesophagectomy procedures. Nutr Diet 2018; 76:135-140. [DOI: 10.1111/1747-0080.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
- John Lahoud
- School of MedicineThe University of Notre Dame Australia Sydney New South Wales Australia
| | - Khalil Bazzi
- School of MedicineThe University of Notre Dame Australia Sydney New South Wales Australia
| | - David Yeo
- Department of Hepatobiliary and Upper Gastrointestinal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Sharon Carey
- Department of Nutrition and DieteticsRoyal Prince Alfred Hospital Sydney New South Wales Australia
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