title: An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma.
abstract: BACKGROUND
  Feeding jejunostomy tubes (J-tube) are often placed during gastrectomy for cancer to decrease malnutrition and promote delivery of adjuvant therapy. We hypothesized that J-tubes actually are associated with increased complications and do not improve nutritional status nor increase rates of adjuvant therapy.
  
  
  METHODS
  One hundred thirty-two patients were identified from a prospectively maintained database that underwent gastric resection for gastric adenocarcinoma between 1/00 and 3/11 at one institution. Pre- and postoperative nutritional status and relevant intraoperative and postoperative parameters were examined.
  
  
  RESULTS
  Median age was 64 years (range 23-85). Forty-six (35%) underwent a total and 86 (65%) a subtotal gastrectomy. J-tubes were placed in 66 (50%) patients, 34 of whom underwent a subtotal and 32 a total gastrectomy. Preoperative nutritional status was similar between J-tube and no J-tube groups as measured by serum albumin (3.5 vs. 3.4 g/dL). Tumor grade, T, N, and overall stage were similar between groups. J-tube placement was associated with increased postop complications (59% vs. 41%, P = 0.04) and infectious complications (36% vs. 17%, P = 0.01), of which majority were surgical site infections. J-tubes were associated with prolonged length of stay (13 vs. 11 days; P = 0.05). There was no difference in postoperative nutritional status as measured by 30, 60, and 90-day albumin levels and the rate of receiving adjuvant therapy was similar between groups (J-tube: 61%, no J-tube: 53%, P = 0.38). Multivariate analyses revealed J-tubes to be associated with increased postop complications (HR: 4.8; 95% CI: 1.3-17.7; P = 0.02), even when accounting for tumor stage and operative difficulty and extent. Subset analysis revealed J-tubes to have less associated morbidity after total gastrectomy.
  
  
  CONCLUSIONS
  J-tube placement after gastrectomy for gastric cancer may be associated with increased postoperative complications with no demonstrable advantage in receiving adjuvant therapy. Routine use of J-tubes after subtotal gastrectomy may not be justified, but may be selectively indicated in patients undergoing total gastrectomy. A prospective trial is needed to validate these results.
authors: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA.
authors: Sameer H
authors: SH
authors: Patel
authors: David A
authors: DA
authors: Kooby
authors: Charles A
authors: CA
authors: Staley
authors: Shishir K
authors: SK
authors: Maithel
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D007582:Jejunostomy / Q000009:adverse effects / Q000706:statistics & numerical data; D007902:Length of Stay; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009752:Nutritional Status; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D013274:Stomach Neoplasms / Q000208:ethnology / Q000601:surgery*; D017211:Treatment Failure
chemical_list: D012709:Serum Albumin