Nutritional Support via Jejunostomy Placed During Staging Laparoscopy for Esophagogastric Cancer: A Case Series.

Background

Malnutrition is associated with poorer clinical outcomes in esophagogastric cancers (EGCs). Enteral nutrition via feeding jejunostomy (FJ) is feasible and effective, although standardized criteria for its placement during staging laparoscopy (SL) are lacking. Here, we describe a case series with the aim of generate preliminary evidence in highlighting unmet needs in this setting.

Methods

We retrospectively reviewed medical records of EGC patients who underwent FJ placement during SL at the Fondazione IRCCS Policlinico S. Matteo from January 2022 to December 2023. Patients with missing nutritional data or known metastatic disease were excluded.

Results

We included 14 Caucasian patients aged 66 years (IQR: 56.3-69.5) with a median Body Mass Index (BMI) of 23.7 kg/m2 (IQR: 21.6-26.3). The tumor location was the gastroesophageal junction in eight cases (57%), the body of the stomach in four cases (29%), and the esophagus in two cases (14%). At the time of diagnosis, all patients had experienced weight loss: 13.4% of body weight (IQR: 8.7-16.8) in the last 6 months; with high malnutrition risk scores: NRS-2002 = 3 (IQR: 2-4) and MUST = 2 (IQR: 1-2). Prior to FJ placement only four (29%) patients had tried oral nutrition supplements (ONS) and nine (64%) had been evaluated by dietitians. Home enteral nutrition (HEN) was started in twelve (86%) cases, with three (21%) providing total enteral nutrition and 9 (64%) as supplemental HEN, providing a median of 45.5% of energy needs (IQR: 32.6-68.2). Due to sufficient oral intake, HEN was not started in two cases (14%) and was discontinued in the first month in another two cases. In this series, FJ was in place but unused for a median duration of 11 days (IQR: 3-91). The median duration of HEN was 97 days (IQR: 40-135); with 5 (35%) patients achieving weight stability/gain. FJ-related complications requiring hospitalization occurred in three (21%) cases.

Conclusions

In this case series, we observed a suboptimal utilization of the FJ. Several patients had not undergone ONS trials or dietitian assessment prior to FJ placement, while others retained the FJ for months without using it. Given the potential risks of FJ, standardized selection criteria are warranted; routine preoperative nutritional assessments before SL should be implemented to identify high-risk patients and optimize FJ placement.