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Article

Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy

1
Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602ZA Eindhoven, The Netherlands
2
Department of Surgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
*
Author to whom correspondence should be addressed.
Academic Editors: Maria Luz Fernandez and Ina Bergheim
Nutrients 2021, 13(10), 3616; https://doi.org/10.3390/nu13103616
Received: 7 July 2021 / Revised: 6 October 2021 / Accepted: 13 October 2021 / Published: 15 October 2021
(This article belongs to the Special Issue Perioperative Nutritional Status and Optimization for Patients)
Recently, it has been shown that directly starting oral feeding (DOF) from postoperative day one (POD1) after a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) can further improve postoperative outcomes. However, in some patients, tube feeding by a preemptively placed jejunostomy is necessary. This single-center cohort study investigated risk factors associated with failure of DOF in patients that underwent a MIE-IL between October 2015 and April 2021. A total of 165 patients underwent a MIE-IL, in which DOF was implemented in the enhanced recovery after surgery program. Of these, 70.3% (n = 116) successfully followed the nutritional protocol. In patients in which tube feeding was needed (29.7%; n = 49), female sex (compared to male) (OR 3.5 (95% CI 1.5–8.1)) and higher ASA scores (III + IV versus II) (OR 2.2 (95% CI 1.0–4.8)) were independently associated with failure of DOF for any cause. In case of failure, this was either due to a postoperative complication (n = 31, 18.8%) or insufficient caloric intake on POD5 (n = 18, 10.9%). In the subgroup of patients with complications, higher ASA scores (OR 2.8 (95% CI 1.2–6.8)) and histological subtypes (squamous-cell carcinoma versus adenocarcinoma and undifferentiated) (OR 5.2 (95% CI 1.8–15.1)) were identified as independent risk factors. In the subgroup of patients with insufficient caloric intake, female sex was identified as a risk factor (OR 5.8 (95% CI 2.0–16.8)). Jejunostomy-related complications occurred in 17 patients (10.3%). In patients with preoperative risk factors, preemptively placing a jejunostomy may be considered to ensure that nutritional goals are met. View Full-Text
Keywords: minimally invasive esophagectomy; esophageal cancer; nutrition; enhanced recovery after surgery; jejunostomy minimally invasive esophagectomy; esophageal cancer; nutrition; enhanced recovery after surgery; jejunostomy
MDPI and ACS Style

Janssen, H.J.B.; Gantxegi, A.; Fransen, L.F.C.; Nieuwenhuijzen, G.A.P.; Luyer, M.D.P. Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy. Nutrients 2021, 13, 3616. https://doi.org/10.3390/nu13103616

AMA Style

Janssen HJB, Gantxegi A, Fransen LFC, Nieuwenhuijzen GAP, Luyer MDP. Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy. Nutrients. 2021; 13(10):3616. https://doi.org/10.3390/nu13103616

Chicago/Turabian Style

Janssen, Henricus J.B., Amaia Gantxegi, Laura F.C. Fransen, Grard A.P. Nieuwenhuijzen, and Misha D.P. Luyer 2021. "Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy" Nutrients 13, no. 10: 3616. https://doi.org/10.3390/nu13103616

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