Optimizing nutritional access in oncology: A five-year experience with feeding jejunostomy

Objectives: Oncological patients often require supplemental feeding due to an inability to consume adequate nutrition. Most surgeons prefer to place a feeding jejunostomy at the time of primary surgery during major oncological cases, but these are not free of complications. In the current era of enhanced recovery protocols, minimal tubes are propagated, and when required, supplementation is provided with parenteral nutrition (PN). We aimed to evaluate the role, benefits, and hazards of feeding jejunostomy in oncologic practice. Material and Methods: This was a retrospective study conducted at a specialized oncology unit over a span of 5 years, from January 2020 to December 2024, including all adult patients undergoing feeding jejunostomy as a part of an oncological procedure or as a standalone procedure. Data were extracted from medical records and the operation theatre (OT)logs. Demographic, clinical, procedure and follow-up data were collected. Standard surgical technique of modified Witzel’s method was used for tube insertion and postoperative feeding with personalised diet charts. Complications were managed as per the treating surgeon's discretion. Results: Out of 613 patients, 534 were included in the final analysis. The mean age of the patients was 52.8 ± 12.3 years. There were 282 males (52.8%) and 252 females (47.2%) in the population. The most common indication for feeding jejunostomy (FJ) was carcinoma oesophagus, followed by periampullary carcinoma (20.2%) and gastric carcinoma. 29% tubes were placed as part of another surgery, and the remaining 21% were for palliative feeding. The most frequently performed procedure was video-assisted thoracoscopic (VATS) esophagectomy (32.5%), followed by Whipple’s procedure (25.8%). Fifty patients received a standalone tube procedure for various indications. FJ-related complications were seen in 97 (18.1%) patients. The most common complication was feed intolerance, seen in 45 (8.4%) patients. Other minor complications, such as tube dislodgement,were seen in 2.8% cases, and 2.2% had peritubal leak. Major complications were seen in 8 cases over the study period. 4 had a leak resulting in enterocutaneous (EC) fistula, 2 cases of obstruction, 1 small bowel volvulus and 1 case of peritonitis. Four patients required re-exploration for obstruction, volvulus and peritonitis. There was no FJ-related mortality. The highest overall complication rate was observed in patients undergoing Whipple’s procedure (29.7%), followed by total gastrectomy (27.8%) and D2 gastrectomy (16.7%). Mean pre - op albumin was 3.2(±0.34), and mean post-operative albumin at day 15 was 2.9 (±0.28). FJ was retained for a mean duration of 17 (±0.7.3) days among the patients where the tube was placed with curative intent surgeries. In 104 patients where there were postoperative complications such as anastomotic leaks, sepsis, or other surgical complications, the mean tube duration was 35 (±0.8.5) days. Conclusion: Feeding jejunostomy is still a viable option for patients undergoing major oncological procedures to supplement nutrition postoperatively, aiding speedy recovery. It has minimal complications, which can be managed conservatively and can be safely removed within a month post-procedure. It is also a well-tolerated option for prolonged sustenance in cases of advanced malignancy.