D. P. Nussbaum1, Z. Sun1, B. C. Gulack1, J. E. Keenan1, D. S. Tyler1, P. J. Speicher1, D. G. Blazer1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA 2Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: Feeding tube placement is common among patients undergoing gastrectomy, and national guidelines currently recommend consideration of a feeding jejunostomy tube (FJT) for all patients undergoing resection of gastric cancer. However, to date there is no comparative effectiveness data regarding the safety of FJT placement at the time of gastrectomy for gastric cancer.
Methods: The 2005-2011 ACS-NSQIP Participant User Files were queried to identify patients who underwent gastrectomy for gastric cancer. Subjects were classified by the concomitant placement of a FJT. Groups were then propensity matched using a 1:1 nearest neighbor algorithm, and outcomes were compared between groups. The primary outcomes of interest were overall 30-day morbidity and mortality. Secondary endpoints included major complications, surgical site infection, and early reoperation.
Results: In total, 2,980 subjects underwent gastrectomy for gastric cancer, among whom 715 (24%) also had a FJT placed. Patients who had a FJT placed were more likely to be male (61.6 vs. 56.6%, p=0.02), have recent weight loss (21.0 vs. 14.8%, p<0.01), and to have undergone recent chemotherapy (7.9 vs. 4.2%, p<0.01) and radiation therapy (4.2 vs. 1.3%, p<0.01). They were also more likely to have undergone total (compared to partial) gastrectomy (66.6 vs. 28.6%, p<0.01) and have concomitant resection of an adjacent organ (40.4 vs. 24.1%, p<0.01). After adjustment with propensity matching, however, all baseline characteristics and treatment variables were highly similar. Among propensity-matched groups, there were no statistically significant differences in either primary outcome: 30-day overall complications (38.8 vs. 36.1%, p=0.32) or mortality (5.8 vs. 3.7%, p=0.08). There were also no differences in major complications, surgical site infection, or early reoperation. Operative time was slightly longer among patients with feeding tubes placed (median 248 vs. 234 minutes, p=0.01), but otherwise there were no significant differences in any outcomes between groups.
Conclusion: Placement of a FJT may result in slightly increased operative times, but does not appear to result in increased perioperative morbidity or mortality. Further investigation is needed to define the patients most likely to benefit from FJT placement.