This minireview synthesizes literature on the use of feeding jejunostomy tubes(FJTs)in the postoperative management of gastroesophageal cancer patients.Gastrectomy and esophagectomy remain the primary curative treatme...This minireview synthesizes literature on the use of feeding jejunostomy tubes(FJTs)in the postoperative management of gastroesophageal cancer patients.Gastrectomy and esophagectomy remain the primary curative treatments for gastric and esophageal cancers,respectively,but are frequently accompanied by significant postoperative malnutrition,which adversely impacts surgical and oncological outcomes as well as patients’quality of life.To address this,the European Society for Clinical Nutrition and Surgery and the National Comprehensive Cancer Network recommend early enteral feeding through FJT placement following major surgery.While previous studies have demonstrated that FJT is an effective and reliable route for nutritional support,its placement is invasive and carries associated risks.Consequently,many clinicians opt for less invasive alternatives such as total parenteral nutrition or nasogastric tube feeding,although these approaches yield variable results.This review explores the benefits and potential complications of FJT placement,identifies variability in clinical adoption and the absence of standardized protocols,and highlights areas for future research to optimize patient care in this challenging context.展开更多
AIM To assess nutritional recovery,particularly regarding feeding jejunostomy tube(FJT)utilization,following upper gastrointestinal resection for malignancy. METHODS A retrospective review was performed of a prospecti...AIM To assess nutritional recovery,particularly regarding feeding jejunostomy tube(FJT)utilization,following upper gastrointestinal resection for malignancy. METHODS A retrospective review was performed of a prospectively-maintained database of adult patients who underwent esophagectomy or gastrectomy(subtotal or total)for cancer with curative intent,from January 2001 to June 2014. Patient demographics,the approach to esophagectomy,the extent of gastrectomy,FJT placement and utilization at discharge,administration of parenteral nutrition(PN),and complications were evaluated. All patients were followed for at least ninety days or until death.RESULTS The 287 patients underwent upper GI resection,comprised of 182 esophagectomy(n=107 transhiatal,58.7%; n=56 Ivor-Lewis,30.7%)and 105 gastrectomy [n=63 subtotal(SG),60.0%; n=42 total(TG),40.0%]. 181 of 182 esophagectomy patients underwent FJT,compared with 47 of 105 gastrectomy patients(99.5% vs 44.8%,P < 0.0001),of whom most had undergone TG(n=39,92.9% vs n=8 SG,12.9%,P < 0.0001). Median length of stay was similar between esophagectomy and gastrectomy groups(14.7 d vs 17.1 d,P=0.076). Upon discharge,87 esophagectomy patients(48.1%)were taking enteral feeds,with 53(29.3%)fully and 34(18.8%)partially dependent. Meanwhile,20 of 39 TG patients(51.3%)were either fully(n=3,7.7%)or partially(n=17,43.6%)dependent on tube feeds,compared with 5 of 8 SG patients(10.6%),all of whom were partially dependent. Gastrectomy patients were significantly less likely to be fully dependent on tube feeds at discharge compared to esophagectomy patients(6.4% vs 29.3%,P=0.0006). PN was administered despite FJT placement more often following gastrectomy than esophagectomy(n=11,23.4% vs n=7,3.9%,P=0.0001). FJT-specific complications requiring reoperation within 30 d of resection occurred more commonly in the gastrectomy group(n=6),all after TG,compared to 1 esophagectomy patient(12.8% vs 0.6%,P=0.0003). Six of 7 patients(85.7%)who experienced tube-related complications required PN.CONCLUSION Nutritional recovery following esophagectomy and gastrectomy is distinct. Operations are associated with unique complication profiles. Nutritional supplementation alternative to jejunostomy should be considered in particular scenarios.展开更多
Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from pla...Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from placement of the tube, mechanical problems related to the location or function and development of focally thickened small-bowel folds. A 76-year old man who presented with multiple medical diseases was admitted to our hospital due to aspiration pneumonia with acute respiratory failure and septic shock. He underwent exploratory laparotomy with feeding jejunostomy using a 14-French nasogastric tube for nutritional support. However, occlusion of the feeding tube was found 30 d after operation, and a rare complication of knot formation in the tube occurred after a new tube was replaced. On the following day, the tube was removed and replaced with a similar tube, which was placed into the jejunum for only 15 cm. The patient's feedings were maintained smoothly for two months. Knot formation in the feeding tube seems to be very rare. To our knowledge, this is the third case in the literature review. Its incidence is probably related to the length of the tube inserted into the lumen.展开更多
Globally,gastric cancer ranks as the fifth most common malignancy and the third leading cause of cancer-related mortality.Gastrectomy combined with periop-erative chemotherapy is currently the standard of care in loca...Globally,gastric cancer ranks as the fifth most common malignancy and the third leading cause of cancer-related mortality.Gastrectomy combined with periop-erative chemotherapy is currently the standard of care in locally advanced stages,but the completion rate of multimodal approach is influenced also by patient related factors.Malnutrition is a well-known risk factor associated with poor oncological outcomes.Its perioperative supplementation could lead to an im-provement of the nutritional status.This article reviews and comments the retro-spective study conducted by Jaquet et al,which evaluates the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.The authors included 172 patients,35%of whom received jejunostomy.Patients with optimized biological nutritional parameters(body mass index,albumin,prealbumin)showed reduced major complications(>III),according to the Dindo-Clavien classification,0(0%)vs 8(4.7%)(P=0.05).In the era of multimodal treatment,optimization of nutritional and performance status is integral part of the therapeutic strategy.展开更多
BACKGROUND Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy.AIM To evaluate the impact of enteral nutrition by jejunostomy feeding i...BACKGROUND Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy.AIM To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.METHODS Between 2003 and 2017,all patients undergoing gastrectomy for cancer treatment were included retrospectively.A group with jejunostomy(J+group)and a group without jejunostomy(J-group)were compared.RESULTS Of the 172 patients included,60 received jejunostomy.Preoperatively,the two groups were comparable with respect to the nutritional parameters studied(body mass index,albumin,etc.).In the postoperative period,the J+group lost less weight and albumin:5.74±8.4 vs 9.86±7.5 kg(P=0.07)and 7.2±5.6 vs 14.7±12.7 g/L(P=0.16),respectively.Overall morbidity was 25%in the J+group and 36.6%in the J-group(P=0.12).The J+group had fewer respiratory,infectious,and grade 3 complications:0%vs 5.4%(P=0.09),1.2%vs 9.3%(P=0.03),and 0%vs 4.7%(P=0.05),respectively.The 30-day mortality was 6.7%in the J+group and 6.3%in the J-group(P=0.91).CONCLUSION Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity.A prospective study could confirm our results.展开更多
Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on pos...Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.展开更多
文摘This minireview synthesizes literature on the use of feeding jejunostomy tubes(FJTs)in the postoperative management of gastroesophageal cancer patients.Gastrectomy and esophagectomy remain the primary curative treatments for gastric and esophageal cancers,respectively,but are frequently accompanied by significant postoperative malnutrition,which adversely impacts surgical and oncological outcomes as well as patients’quality of life.To address this,the European Society for Clinical Nutrition and Surgery and the National Comprehensive Cancer Network recommend early enteral feeding through FJT placement following major surgery.While previous studies have demonstrated that FJT is an effective and reliable route for nutritional support,its placement is invasive and carries associated risks.Consequently,many clinicians opt for less invasive alternatives such as total parenteral nutrition or nasogastric tube feeding,although these approaches yield variable results.This review explores the benefits and potential complications of FJT placement,identifies variability in clinical adoption and the absence of standardized protocols,and highlights areas for future research to optimize patient care in this challenging context.
文摘AIM To assess nutritional recovery,particularly regarding feeding jejunostomy tube(FJT)utilization,following upper gastrointestinal resection for malignancy. METHODS A retrospective review was performed of a prospectively-maintained database of adult patients who underwent esophagectomy or gastrectomy(subtotal or total)for cancer with curative intent,from January 2001 to June 2014. Patient demographics,the approach to esophagectomy,the extent of gastrectomy,FJT placement and utilization at discharge,administration of parenteral nutrition(PN),and complications were evaluated. All patients were followed for at least ninety days or until death.RESULTS The 287 patients underwent upper GI resection,comprised of 182 esophagectomy(n=107 transhiatal,58.7%; n=56 Ivor-Lewis,30.7%)and 105 gastrectomy [n=63 subtotal(SG),60.0%; n=42 total(TG),40.0%]. 181 of 182 esophagectomy patients underwent FJT,compared with 47 of 105 gastrectomy patients(99.5% vs 44.8%,P < 0.0001),of whom most had undergone TG(n=39,92.9% vs n=8 SG,12.9%,P < 0.0001). Median length of stay was similar between esophagectomy and gastrectomy groups(14.7 d vs 17.1 d,P=0.076). Upon discharge,87 esophagectomy patients(48.1%)were taking enteral feeds,with 53(29.3%)fully and 34(18.8%)partially dependent. Meanwhile,20 of 39 TG patients(51.3%)were either fully(n=3,7.7%)or partially(n=17,43.6%)dependent on tube feeds,compared with 5 of 8 SG patients(10.6%),all of whom were partially dependent. Gastrectomy patients were significantly less likely to be fully dependent on tube feeds at discharge compared to esophagectomy patients(6.4% vs 29.3%,P=0.0006). PN was administered despite FJT placement more often following gastrectomy than esophagectomy(n=11,23.4% vs n=7,3.9%,P=0.0001). FJT-specific complications requiring reoperation within 30 d of resection occurred more commonly in the gastrectomy group(n=6),all after TG,compared to 1 esophagectomy patient(12.8% vs 0.6%,P=0.0003). Six of 7 patients(85.7%)who experienced tube-related complications required PN.CONCLUSION Nutritional recovery following esophagectomy and gastrectomy is distinct. Operations are associated with unique complication profiles. Nutritional supplementation alternative to jejunostomy should be considered in particular scenarios.
文摘Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from placement of the tube, mechanical problems related to the location or function and development of focally thickened small-bowel folds. A 76-year old man who presented with multiple medical diseases was admitted to our hospital due to aspiration pneumonia with acute respiratory failure and septic shock. He underwent exploratory laparotomy with feeding jejunostomy using a 14-French nasogastric tube for nutritional support. However, occlusion of the feeding tube was found 30 d after operation, and a rare complication of knot formation in the tube occurred after a new tube was replaced. On the following day, the tube was removed and replaced with a similar tube, which was placed into the jejunum for only 15 cm. The patient's feedings were maintained smoothly for two months. Knot formation in the feeding tube seems to be very rare. To our knowledge, this is the third case in the literature review. Its incidence is probably related to the length of the tube inserted into the lumen.
文摘Globally,gastric cancer ranks as the fifth most common malignancy and the third leading cause of cancer-related mortality.Gastrectomy combined with periop-erative chemotherapy is currently the standard of care in locally advanced stages,but the completion rate of multimodal approach is influenced also by patient related factors.Malnutrition is a well-known risk factor associated with poor oncological outcomes.Its perioperative supplementation could lead to an im-provement of the nutritional status.This article reviews and comments the retro-spective study conducted by Jaquet et al,which evaluates the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.The authors included 172 patients,35%of whom received jejunostomy.Patients with optimized biological nutritional parameters(body mass index,albumin,prealbumin)showed reduced major complications(>III),according to the Dindo-Clavien classification,0(0%)vs 8(4.7%)(P=0.05).In the era of multimodal treatment,optimization of nutritional and performance status is integral part of the therapeutic strategy.
文摘BACKGROUND Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy.AIM To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.METHODS Between 2003 and 2017,all patients undergoing gastrectomy for cancer treatment were included retrospectively.A group with jejunostomy(J+group)and a group without jejunostomy(J-group)were compared.RESULTS Of the 172 patients included,60 received jejunostomy.Preoperatively,the two groups were comparable with respect to the nutritional parameters studied(body mass index,albumin,etc.).In the postoperative period,the J+group lost less weight and albumin:5.74±8.4 vs 9.86±7.5 kg(P=0.07)and 7.2±5.6 vs 14.7±12.7 g/L(P=0.16),respectively.Overall morbidity was 25%in the J+group and 36.6%in the J-group(P=0.12).The J+group had fewer respiratory,infectious,and grade 3 complications:0%vs 5.4%(P=0.09),1.2%vs 9.3%(P=0.03),and 0%vs 4.7%(P=0.05),respectively.The 30-day mortality was 6.7%in the J+group and 6.3%in the J-group(P=0.91).CONCLUSION Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity.A prospective study could confirm our results.
文摘Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.
