title: Reassessment of the role of enteral tube feedings for patients with esophageal cancer.
abstract: Nutrition is important for patients with esophageal cancer because dysphagia can be exacerbated by chemoradiotherapy. Some centers suggest routine enteral tube placement (TF) to facilitate nutrition. This investigation was to evaluate the use of TF access for patients undergoing multimodality therapy for esophageal carcinoma. This retrospective study analyzed 113 patients who underwent esophagectomy and 97 patients who underwent definition chemoradiotherapy for esophageal cancer between 2001 and 2013. Throughout this time period, a strategy for selective tube placement was used. Nutrition was assessed through absolute lymphocyte counts, protein, and albumin levels. A total of 28 (30%) patients during preoperative chemoradiotherapy and 31 (32%) of those undergoing definitive chemoradiation received TFs. There were 16 Dobhoff tubes, 28 gastrostomy tubes, and 15 jejunostomies. Tubes were maintained an average of 3.9 months with 20 (34%) of these patients reporting tube-related complications. At the time of surgery, there was no statistical difference in any of the nutritional assessments between those patients who received TF and those who did not. Both groups experienced similar total postoperative complication rates (64% vs 65%) and similar median length of hospital stay (12 to 13 days). Chemoradiotherapy resulted in decreased nutritional parameters; however, there was no difference in the degree of reduction between those who underwent TF and those who did not. The data show that routine placement of enteral access is not necessary for esophageal carcinoma. In fact, the risks of placing enteral access may outweigh the benefits. Administration of TF should be restricted to select patients during chemoradiotherapy or before esophagectomy.
authors.affiliation: Surgical Oncology Service, Departments of General Surgery and Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Starr
authors.forename: Stephanie
authors.initials: S
authors.lastname: Davis
authors.forename: Diandra
authors.initials: D
authors.lastname: Ayala-Peacock
authors.forename: William A
authors.initials: WA
authors.lastname: Blackstock
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D004750:Enteral Nutrition / Q000379:methods*; D004938:Esophageal Neoplasms / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome