초록접수 현황
| 20F-206 | 구연 발표 |
Necessity of feeding jejunostomy after Ivor Lewis operation
Min Soo Kim M.D., JongHo Cho M.D.PhD., JaeIl Zo M.D.Ph.D., Yong Soo Choi M.D.Ph.D.,Hong Kwan Kim M.D.Ph.D.,Young Mok Shim M.D.Ph.D.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
Purpose : Feeding jejunostomy was routinely placed during esophagectomy to ensure postoperative enteral feeding. Improved anastomosis technique and early oral feeding strategy after esophagectomy has led to question the need for routine placement of feeding jejunostomy. The aim of this study is to evaluate necessity of feeding jejunostomy during Ivor Lewis operation.
Methods : We retrospectively reviewed 554 patients who underwent Ivor Lewis operations from January 2015 to December 2018.
Results : Of the 554 patients, 61 patients (11.0%) received intraoperative jejunostomy insertion. The most common indication for intraoperative jejunostomy was neoadjuvant CCRT. 48 patients (79%) had jejunostomy removed within 60 days after the surgery and the longest duration of jejunostomy inserted state was 121 days. About two-third (40/61) of the patients with intraoperative jejunostomy had never prescribed with Encover® nor any other enteral feeding product. Among 493 patients without intraoperative jejunostomy, 11(2.2%) received delayed jejunostomy insertion. Graft-related problems (6 patients), cancer progression (3 patients), acute lung injury (1 patient), and swallowing difficulty (1 patient) were reasons for delayed jejunostomy insertion. Complication rate was relatively high as 24 patients (33.3%) out of 72 patients with jejunostomy insertion had complications and 7 patients (9.7%) visited ER more than twice with jejunostomy-related complications.
Conclusion : Only 2.7% patients who underwent Ivor Lewis operation during 4-year span had anastomosis leakage. Although one-third of the patients with intraoperative jejunostomy were benefited with alternative method of feeding after discharge and one can argue nutritional support advantage with feeding jejunostomy, we believe high complication rate regarding feeding jejunostomy outweigh the benefit of feeding jejunostomy.
Methods : We retrospectively reviewed 554 patients who underwent Ivor Lewis operations from January 2015 to December 2018.
Results : Of the 554 patients, 61 patients (11.0%) received intraoperative jejunostomy insertion. The most common indication for intraoperative jejunostomy was neoadjuvant CCRT. 48 patients (79%) had jejunostomy removed within 60 days after the surgery and the longest duration of jejunostomy inserted state was 121 days. About two-third (40/61) of the patients with intraoperative jejunostomy had never prescribed with Encover® nor any other enteral feeding product. Among 493 patients without intraoperative jejunostomy, 11(2.2%) received delayed jejunostomy insertion. Graft-related problems (6 patients), cancer progression (3 patients), acute lung injury (1 patient), and swallowing difficulty (1 patient) were reasons for delayed jejunostomy insertion. Complication rate was relatively high as 24 patients (33.3%) out of 72 patients with jejunostomy insertion had complications and 7 patients (9.7%) visited ER more than twice with jejunostomy-related complications.
Conclusion : Only 2.7% patients who underwent Ivor Lewis operation during 4-year span had anastomosis leakage. Although one-third of the patients with intraoperative jejunostomy were benefited with alternative method of feeding after discharge and one can argue nutritional support advantage with feeding jejunostomy, we believe high complication rate regarding feeding jejunostomy outweigh the benefit of feeding jejunostomy.
책임저자: Young-mok Shim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
발표자: Min Soo Kim, E-mail : aqms78@naver.com