Complications related to the routine use of feeding jejunostomy in esophageal cancer surgery within an enhanced recovery protocol.

BACKGROUND AND AIMS: To evaluate the feasibility, safety, and impacts of routine surgically placed feeding jejunostomy (FJ) and early enteral feeding (EF) in patients undergoing esophagectomy for esophageal cancer within an Enhanced Recovery Protocol (ERP), focusing on adverse events (FJ-AE and EF-AE).

METHODS

This monocentric retrospective observational study analyzed 738 consecutive patients with resectable esophageal or gastroesophageal junction carcinoma treated at University Hospitals Leuven from May 2017 to December 2023. All followed an ERP with routine FJ placement during esophagectomy (or pre-neoadjuvant staging laparoscopy in select cases). Data from a prospective database and medical records were reviewed for demographics, weights/BMI, all recorded FJ-AE, EF intolerance during the postoperative course, up to five years after surgery, when available, or date of death.

RESULTS

The mean age was 65 years (range 24-90), with a majority being male (81%). About 77.5% had adenocarcinoma and were at an advanced stage. Neoadjuvant therapy was performed before surgery in 71%. FJ-AE impacted 361 (48.9%) patients, increasing to 419 (58.5%) when including EF-AE. After categorizing AEs, 310 (42%) were deemed non-serious, while 109 (14.8%) were considered serious, with 7 (0.9%) contributing to mortality. Late, serious complications occurred in 33 (4.5%) patients. The mean EF usage and FJ lifespan varied based on several factors: longer for older patients, those with non-adenocarcinoma, and higher NRS2002 scores, but shorter in minimally invasive approaches and patients with higher BMIs. Patients who experienced an anastomotic leak after surgery or required adjuvant therapy had longer EF usage and FJ duration.

CONCLUSIONS

Routine FJ placement in esophagectomy yields high AE rates, conflicting with ERP goals of complication reduction. Selective placement in malnourished/high-risk patients, guided by the latest ESPEN/ERAS guidelines, may minimize burdens while preserving nutritional benefits. Multicenter trials are warranted for tailored strategies.