Abstract
Esophageal cancer patients are at high risk for malignancy-related malnutrition. Jejunostomy tube placement is regularly performed in this patient population to provide nutritional support. Jejunostomy complications are common but are typically manageable in the outpatient setting. However, the degree of complications range in severity. The purpose of this paper is to describe jejunostomy complications and patient outcomes based on placement timing.
This is a retrospective review of a database maintained by two academic hospital systems from 2005-2023. Esophageal cancer patients who underwent esophagectomy and received a jejunostomy tube during their treatment were included. Multi-institutional IRB approval was obtained for this study.
A total of 148 patients met inclusion criteria. Of these patients, 79% (117) were male and the mean age was 63. Early jejunostomy placement occurred in 38 patients and routine jejunostomy placement at the time of esophagectomy occurred in 110 patients. Patients who received early jejunostomy placement were more likely to have symptoms related to their esophageal cancer (p=0.028). All patients who had early jejunostomy placement completed neoadjuvant chemoradiotherapy compared to 78% completion in patients with routine placement (p=0.006). There were no differences in surgical outcomes between groups.
When examining jejunostomy complications, there were no differences in complication rates between groups. The most common complication was dislodgement/removal (35). A total of 8 readmissions were required for jejunostomy-related complications.
Early jejunostomy placement, particularly in symptomatic patients, may increase neoadjuvant therapy completion rates. There are no differences in surgical outcomes or complication rates when comparing early and routine jejunostomy placement in patients who undergo esophagectomy for esophageal cancer. Most jejunostomy complications did not warrant inpatient admission, and creating an efficient outpatient management program for this patient population may be a way to better manage complications.