Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy

• Published in: Nutrients Vol. 13; no. 10; p. 3616
• Main Authors: Janssen, Henricus J. B., Gantxegi, Amaia, Fransen, Laura F. C., Nieuwenhuijzen, Grard A. P., Luyer, Misha D. P.
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 15.10.2021; MDPI
• Subjects: Adenocarcinoma; Catheters; Complications; Diet; Dysphagia; enhanced recovery after surgery; Enteral nutrition; Esophageal cancer; Feeding; Hospitals; jejunostomy; Medical personnel; minimally invasive esophagectomy; nutrition; Nutrition research; Ostomy; Patients; Pneumonia; Postoperative; Postoperative period; Recovery (Medical); Risk analysis; Risk factors; Software; Squamous cell carcinoma; Subgroups; Surgery; Surgical outcomes
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu13103616

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.