OGC O03 - Clinical Outcomes of Routine Jejunostomy Feeding Following Oesophagectomy

Abstract Background Malnutrition negatively affects treatment outcomes of patients with oesophageal cancer post-oesophagectomy. Chemo(radio)therapy exacerbates nutritional deficits, and thus strategies to ensure adequate nutritional intake are necessary. Feeding jejunostomies are commonly used for nutritional support to maintain nutrition and reduce the effect of complications but may be associated with increased morbidity. This study examines the impact of routine post-operative jejunostomy feeding on postoperative weight loss in patients who have undergone oesophagectomy. Method A retrospective review of patients undergoing oesophagectomy between January 2012-December 2014 and January 2016-December 2019 at a single oesophagogastric unit was performed. Routine post operative feeding with overnight feeding on discharge was introduced in 2015. 507 patients were identified and separated into two groups (245 without routine post operative jejunostomy feeding, 262 with routine feeding). Primary outcomes measured included post operative weight loss (2 weeks, 6 weeks, 3 months and 6 months). Secondary outcomes investigated included length of hospital stay, complications and long-term survival. Subgroup analyses were performed on patients who have experienced complications and those receiving different treatments. Results Weight loss was less in patients discharged with jejunostomy feeding at 2 weeks, 6 weeks, 3 months, 6 months (2.92kg vs 5.49kg, 3.39kg vs 6.37kg, 4.81kg vs 7.96kg, 7.25kg vs 9.285kg, p<0.05). In those with complications, routine feeding resulted in less weight loss up to 3 months (p<0.05). Jejunostomy feeding experienced less weight loss in subgroups surgery alone (7.99kg vs 8.72kg, p<0.001), neoadjuvant therapy with surgery (8.02kg vs 9.90kg, p<0.05), and neoadjuvant therapy, surgery with adjuvant therapy (6.29kg vs 9.14kg, p<0.05). Average hospital stay was 16 days with feeding, 19 days without. Long-term survival was greater with jejunostomy feeding (P=0.04). Conclusion Post-operative jejunal feeding is associated with significantly reduced post operative weight loss. This is reflected in patients who received surgery alone, neoadjuvant therapy with surgery and neoadjuvant therapy with surgery and adjuvant therapy. Patients with complications who had routine jejunostomy feeding also experienced significantly less weight loss than those without routine jejunostomy feeding. Routine jejunostomy feeding is associated with a shorter length of hospital stay and is associated with a greater long-term survival.