f0a6b6e0ded6aa5d42da65736dc0fe5b 293185.pdf 555f8586985426b4eb508e954de886730eb86ea6 293185.pdf 8d9fdd9db52abe33cae6056d7bc78d858e7b733a56dc2fd15c7ee3d3ce71586b 293185.pdf Title: Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy Subject: 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. Keywords: minimally invasive esophagectomy; esophageal cancer; nutrition; enhanced recovery after surgery; jejunostomy Author: Henricus J.B. Janssen, Amaia Gantxegi, Laura F.C. Fransen, Grard A.P. Nieuwenhuijzen and Misha D.P. Luyer Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Oct 21 09:10:14 2021 CEST ModDate: Thu Oct 21 09:12:24 2021 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 286413 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- CQZVIY+VnURWPalladioL Type 1 Custom yes yes no 10 0 AQLXMI+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 SMHFNW+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 FEIDOT+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 32 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 54 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 58 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 62 0 JDUPKS+CMSY10 Type 1 Builtin yes yes no 77 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 84 0 NWWXFZ+EURM10 Type 1 Builtin yes yes no 91 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-06-07 02:37:03 CEST RepresentationInformation: 293185.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-06-06 08:52:12 CEST Size: 286413 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 289 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Perioperative Procedure Destination: subsection.2.2 Item: Title: Definitions Destination: subsection.2.3 Item: Title: Statistical Analyses Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Baseline Characteristics Destination: subsection.3.1 Item: Title: Postoperative Outcomes Destination: subsection.3.2 Item: Title: Nutritional Protocol Deviation Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy Author: Henricus J.B. Janssen, Amaia Gantxegi, Laura F.C. Fransen, Grard A.P. Nieuwenhuijzen and Misha D.P. Luyer Subject: 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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