Risk factors for failure of direct oral feeding following a totally minimally invasive esophagectomy
Janssen, Henricus J. B. (Catharina Hospital Eindhoven (Eindhoven, Països Baixos))
Gantxegi Madina, Amaia (Vall d'Hebron Institut de Recerca (VHIR))
Fransen, Laura F.C. (Catharina Hospital Eindhoven (Eindhoven, Països Baixos))
Nieuwenhuijzen, Grard A.P. (Catharina Hospital Eindhoven (Eindhoven, Països Baixos))
Luyer, M. (Catharina Hospital Eindhoven (Eindhoven, Països Baixos))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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.
Nota:	Funding: The previous NUTRIENT II trial was funded by KWF Kankerbestrijding (Dutch Cancer Society, grant number 10495) and Medtronic (20130529).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Enhanced recovery after surgery ; Esophageal cancer ; Jejunostomy ; Minimally invasive esopha
Publicat a:	Nutrients, Vol. 13 Núm. 10 (october 2021) , p. 3616, ISSN 2072-6643

DOI: 10.3390/nu13103616
PMID: 34684617

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