An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. gastric cancer collaborative - PubMed (original) (raw)

Multicenter Study

. 2015 Aug;112(2):195-202.

doi: 10.1002/jso.23983. Epub 2015 Aug 4.

Malcolm H Squires 3rd 1, Lauren M Postlewait 1, David A Kooby 1, George A Poultsides 2, Sharon M Weber 3, Mark Bloomston 4, Ryan C Fields 5, Timothy M Pawlik 6, Konstantinos I Votanopoulos 7, Carl R Schmidt 4, Aslam Ejaz 6, Alexandra W Acher 3, David J Worhunsky 2, Neil Saunders 4, Edward A Levine 7, Linda X Jin 5, Clifford S Cho 3, Emily R Winslow 3, Maria C Russell 1, Kenneth Cardona 1, Charles A Staley 1, Shishir K Maithel 1

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Multicenter Study

An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. gastric cancer collaborative

Gregory C Dann et al. J Surg Oncol. 2015 Aug.

Abstract

Background: Jejunostomy feeding tubes (J-tubes) are often placed during resection for gastric adenocarcinoma (GAC). Their effect on postoperative complications and receipt of adjuvant therapy is unclear.

Methods: Patients who underwent curative-intent resection of GAC at seven institutions of the U.S. Gastric Cancer Collaborative from 2000 to 2012 were identified. The associations of J-tubes with postoperative complications and receipt of adjuvant therapy were determined.

Results: Of 837 patients, 265 (32%) received a J-tube. Patients receiving J-tubes demonstrated greater incidence of preoperative weight loss, lower BMI, greater extent of resection, and more advanced TNM stage. J-tube placement was associated with increased infectious complications (36% vs. 19%; P < 0.001), including surgical-site (14% vs. 6%; P < 0.001) and deep intra-abdominal (11% vs. 4%; P < 0.001) infections. On multivariate analysis, J-tubes remained independently associated with increased risk of infectious complications (all: HR = 1.93; P = 0.001; surgical-site: HR = 2.85; P = 0.001; deep intra-abdominal: HR = 2.13; P = 0.04). J-tubes were not associated with increased receipt of adjuvant therapy (HR = 0.82; P = 0.34). Subset analyses of patients undergoing total and subtotal gastrectomy similarly demonstrated an association of J-tubes with increased risk of infectious outcomes and no association with increased receipt of adjuvant therapy.

Conclusions: J-tube placement after resection of gastric adenocarcinoma is associated with increased postoperative infectious outcomes and is not associated with increased receipt of adjuvant therapy. Selective use of J-tubes is recommended.

Keywords: chemotherapy; complications; gastric cancer; jejunostomy tube; resection.

© 2015 Wiley Periodicals, Inc.

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