Technical notes and outcomes of robot-assisted and laparoscopic jejunostomy placement for tube feeding after esophagectomy

Abstract

Background: Recent studies reported considerable jejunostomy-related morbidity after esophagectomy, questioning the appropriateness of jejunostomy tube feeding for esophageal cancer patients. This study aimed to describe a technique for (robot-assisted) laparoscopic jejunostomy tube placement and to report its associated outcomes in patients undergoing minimally invasive esophagectomy (MIE). Methods: In this observational cohort study, patients who underwent MIE with (robot-assisted) laparoscopic jejunostomy tube placement were included from the prospective databases of two centers (2010-2019). Main endpoints included the incidence of jejunostomy-related complications, the duration of jejunostomy tube feeding, and weight change between surgery and 3- and 6-month follow-up. Patient characteristics were compared between patients who had jejunostomy-related complications versus patients who did not. Results: Jejunostomy-related complications occurred in 13 out of 93 patients (14%) and all involved infections. No intestinal torsions occurred in this cohort. Re-operation for jejunostomy-related infection was required in 1 patient (1%). Pre-existent comorbidity (100% vs. 71%, P=0.033), and diabetes mellitus in particular (31% vs. 9%, P=0.044), were significantly more common in patients with jejunostomy-related infections compared to patients without such complications. Jejunostomy tubes were removed earlier in patients with jejunostomy-related complications [median day 21 (IQR, 11-61) vs. day 37 (IQR, 28-72), P=0.049]. Conclusions: Minimally invasive jejunostomy tube placement with additional anti-rotation fixation, either robotically or laparoscopically, is a safe and advisable way of establishing the enteral feeding route in patients undergoing MIE.