Feeding via duodenostomy can reduce intestinal obstruction after radical resection of esophageal cancer better than jejunostomy

BACKGROUND: Enteral nutrition (EN) is superior to parenteral nutrition (PN) in improving the nutritional status of esophageal cancer (EC) patients and accelerating postoperative recovery. Therefore, feeding via jejunostomy (FJ) is currently placed during esophagectomy to maintain the postoperative nutrition supply. However, FJ have some serve complications. The aim of this study was to explore the value of feeding via duodenostomy (FD) in reducing the complications associated with FJ. METHODS: In this retrospective cohort study, the clinical data of 154 patients with EC who underwent surgical treatment in our center from January 1, 2020, to June 30, 2020 were collected. A concurrent, nonrandomized control group of 154 patients underwent thoraco-laparoscopic esophagectomy (TLE) was enrolled consisting of 82 males and 72 females. These patients were randomly divided into two groups according to the different ostomy method applied, including 80 cases in the FD group and 74 cases in the FJ group. The ostomy-related complications during the 180-day follow-up and indicators including perioperative nutritional markers, length of stay (LoS), and operative time were recorded. RESULTS: After 1 week, the albumin level in the FD group was noninferior to that in the FJ group (36.8 vs. 36.3 g/L; P=0.792), and the prealbumin level also showed no significant difference (178 vs. 176 g/L; P=0.347). Four weeks later, there was significant difference in levels of albumin (42 vs. 41 g/L; P=0.018) but no significant difference prealbumin (225 vs. 222.89 g/L; P=0.493). The LoS was similar between the 2 groups (7 vs. 7.21 days; P=0.697). In terms of the time of stoma creation, it was significantly longer in the FD group than in the FJ group (20 vs. 12 minutes; P<0.001); however, it did not bring a significant impact on the overall procedure length (240 vs. 230.69 minutes; P=0.057). The incidence of postoperative complications (e.g., intestinal obstruction) was significantly lower in the FD group than in the FJ group (P=0.017). CONCLUSIONS: The method of FD is safe, effective and acceptable. It is worthwhile to use in clinic practice.