Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy .
KeywordsGastrectomyJejunostomyFeeding Jejunostomy TubeEnteral NutritionGastric Cancer
Parkin, D.M., Bray, F., Ferlay, K. and Pisani, P. (2005) Global Cancer Statistics, 2002. CA: A Cancer Journal for Clinicians, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
Australian Institute of Health and Welfare (2014) Cancer in Australia: An Overview 2014. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129550202
Earle, C. and Mamon, M.D. (2016) Adjuvant and Neoadjuvant Treatment of Gastric Cancer. http://www.uptodate.com/contents/adjuvant-and-neoadjuvant-treatment-of-gastric-cancer
Cunningham, D., Allum, W.H., Stenning, S.P., Thompson, J.N., Van de Velde, C.J., Nicolson, M., et al. (2006) Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. The New England Journal of Medicine, 355, 11-20. https://doi.org/10.1056/NEJMoa055531
Khomichuk, A.L., Shakhovskaia, A.K., Isakov, V.A., Sharefetdinov, Kh.Kh. and Blokhina, L.V. (2012) Nutritional Status in Patients after Gastrectomy Due to Gastric Cancer. Voprosy Pitaniia, 81, 29-34.
Cidon, E.U. (2010) Nutritional Status after Total Gastrectomy for Gastric Cancer. World Journal of Oncology, 1, 87-90. https://doi.org/10.4021/wjon2010.04.196w
Papini-Berto, S.J. and Burini, R.C. (2001) Causes of Malnutrition in Post-Gastrectomy Patient. Arqivos de Gastroenterologia, 38, 272-275.
Buzby, G.P., Mullen, J.L., Matthews, D.C., Hobbs, C.L. and Rosato, E.F. (1980) Prognostic Nutritional Index in Gastrointestinal Surgery. The American Journal of Surgery, 139, 160-167. https://doi.org/10.1016/0002-9610(80)90246-9
Giner, M., Lavian, A., Meguid, M.M. and Gleason, J.R. (1996) In 1995 a Correlation between Malnutrition and Poor Outcome in Critically Ill Patients Still Exists. Nutrition, 12, 23-29. https://doi.org/10.1016/0899-9007(95)00015-1
Mezhir, J.J., Tang, L.H. and Coit, D.G. (2010) Neoadjuvant Therapy of Locally Advanced Gastric Cancer. Journal of Surgical Oncology, 101, 305-314. https://doi.org/10.1002/jso.21483
Heylen, A.M., Lybeer, M.B., Penninckx, F.M., Kerremans, R.P. and Frost, P.G. (1987) Parenteral versus Needle Jejunostomy Nutrition after Total Gastrectomy. Clinical Nutrition, 6, 131-136. https://doi.org/10.1016/0261-5614(87)90046-X
Baker, A., Wooten, L.A. and Malloy, M. (2011) Nutritional Considerations after Gastrectomy and Esophagectomy for Malignancy. Current Treatment Options in Oncology, 12, 85-95. https://doi.org/10.1007/s11864-010-0134-0
Chen, W., Zhang, Z., Xiong, M., Meng, X., Dai, F., Fang, J., et al. (2014) Early Enteral Nutrition after Total Gastrectomy for Gastric Cancer. Asian Pacific Journal of Clinical Nutrition, 23, 607-611.
Wheble, G.A., Knight, W.R. and Khan, O.A. (2012) Enteral vs. Total Parenteral Nutrition Following Major Upper Gastrointestinal Surgery. International Journal of Surgery, 10, 194-197. https://doi.org/10.1016/j.ijsu.2012.02.015
Sica, G.S., Sujendran, V., Wheeler, J., Soin, B. and Maynard, N. (2005) Needle Catheter Jejunostomy at Esophagectomy for Cancer. Journal of Surgical Oncology, 91, 276-279. https://doi.org/10.1002/jso.20314
Couper, J. (2011) Jejunostomy after Oesophagectomy: A Review of Evidence and Current Practice. The Proceedings of the Nutrition Society, 70, 316-320. https://doi.org/10.1017/S0029665111000553
Rajabi Mashhadi, M.T., Bagheri, R., Ghayour-Mobarhan, M., Zilaee, M., Rezai, R., Maddah, G., et al. (2015) Early Post Operative Enteral versus Parenteral Feeding after Esophageal Cancer Surgery. Iranian Journal of Otorhinolaryngology, 27, 331-336.
Gerndt, S.J. and Orringer, M.B. (1994) Tube Jejunostomy as an Adjunct to Esophagectomy. Surgery, 115, 164-169.
Weimann, A., Braga, M., Harsanyi, L., Laviano, A., Ljungqvist, O., Soeters, P., et al. (2006) ESPEN Guidelines on Enteral Nutrition: Surgery including Organ Transplantation. Clinical Nutrition, 25, 224-244. https://doi.org/10.1016/j.clnu.2006.01.015
Lochs, H., Dejong, C., Hammarqvist, F., Hebuterne, X., Leon-Sanz, M., Schütz, T., et al. (2006) ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clinical Nutrition, 25, 260-274. https://doi.org/10.1016/j.clnu.2006.01.007
Weijs, T.J., Berkelmans, G.H.K., Niewnhuijzen, G.A.P., Ruurda, J.P., Hillegersbeg, R.V., Soeters, P.B., et al. (2015) Routes for Early Enteral Nutrition after Esophagectomy. A Systematic Review. Clinical Nutrition, 34, 1-6. https://doi.org/10.1016/j.clnu.2014.07.011
Heyland, D.K., MacDonald, S., Keefe, M. and Drover, J.W. (1998) Total Parenteral Nutrition in the Critically Ill Patient: A Meta-Analysis. The Journal of the American Medical Association, 280, 2013-2019. https://doi.org/10.1001/jama.280.23.2013
OCEBM Levels of Evidence Working Group (2011) The Oxford Levels of Evidence 2. http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf
Dann, G.C., Squires, M.H., Postlewait, L.M., Kooby, D.A., Poulstides, G.A., Weber, S.M., et al. (2015) An Assessment of Feeding Jejunostomy Tube Placement at the Time of Resection for Gastric Adenocarcinoma: A Seven-Institution Analysis of 837 Patients from the US Gastric Cancer Collaborative. Journal of Surgical Oncology, 112, 195-202. https://doi.org/10.1002/jso.23983
Patel, S.H., Kooby, D.A., Staley, C.A. and Maithel, S.K. (2013) An Assessment of Feeding Jejunostomy Tube Placement at the Time of Resection for Gastric Adenocarcinoma. Journal of Surgical Oncology, 107, 728-734. https://doi.org/10.1002/jso.23324
Wu, Q., Yu, J.C., Kang, W.M. and Ma, Z.Q. (2011) Short-Term Effects of Supplementary Feeding with Enteral Nutrition via Jejunostomy Catheter on Post-Gastrectomy Gastric Cancer Patients. Chinese Medical Journal, 124, 97-301.
Sun, Z., Shenoi, M.M., Nussbaum, D.P., Keenan, J.E., Gulack, B.C., Tyler, D.S., et al. (2016) Feeding Jejunostomy Tube Placement during Resection of Gastric Cancers. Journal of Surgical Research, 200, 189-194. https://doi.org/10.1016/j.jss.2015.07.014
Vaithiswaran, V., Srinivasan, K. and Kadambari, D. (2008) Effect of Early Enteral Feeding after Upper Gastrointestinal Surgery. Tropical Gastroenterology, 29, 91-94.
Osland, E.J. and Memon, M.A. (2010) Early Postoperative Feeding in Resectional Gastrointestinal Surgical Cancer Patients. World Journal of Gastrointestal Oncology, 2, 187-191. https://doi.org/10.4251/wjgo.v2.i4.187
Blumenstein, I., Shastri, Y.M. and Stein, J. (2014) Gastroenteric Tube Feeding: Techniques, Problems and Solutions. World Journal of Gastroenterology, 20, 8505-8524. https://doi.org/10.3748/wjg.v20.i26.8505