Relationship Between Different Nutritional Modalities and Tumor Prognosis After Minimally Invasive Esophagectomy

Esophageal cancer ranks ninth globally in terms of cancer incidence and sixth in terms of cancer deaths. In addition to the tumor itself and the surgical strike, nutrition and complications are two key factors limiting the rapid recovery of esophagectomy patients. A large number of studies have shown that rational nutritional support will help to improve the nutritional status of postoperative patients and reduce the risk of complications, and compared with parenteral nutrition, enteral nutrition has the advantages of lower complication rate, more economical and safer. Therefore, enteral nutrition is often recommended for esophageal cancer patients in the early postoperative period.

However, the commonly used clinical enteral nutrition includes transoral, nasoenteric tube (NT), gastrostomy and jejunostomy tube (JT) feeding. The optimal method of enteral nutrition after esophageal cancer surgery has been hotly debated in various published articles, but contradictions still exist. There have been numerous studies in recent years on the routine placement of jejunostomy tubes after esophageal cancer surgery, but none of them has yet reached an unanimously accepted conclusion.

Theoretically, a JT reduces the risk of detachment compared with an NT because the catheter is sutured to the abdominal wall; at the same time, a JT is placed deeper than an NT and farther away from the pyloric inlet, thus reducing the incidence of reflux. Most importantly, jejunostomy is considered to be comfortable and effective for long-term nutritional support, and patients can achieve long-term tube feeding at home through the JT, which can satisfy early discharge in case of insufficient oral intake and prevent readmission due to insufficient transoral intake.

Some studies have also confirmed these views, claiming that jejunostomy does not increase the incidence of total complications but improves QOL scores and short-term nutritional indices. It also eliminates the foreign body sensation of nasal mucosal nutritional tubes, and these patients showed acceptable tolerance to catheter insertion. Some researchers have also shown that jejunostomy does not affect the long-term oncological outcomes of patients undergoing esophageal cancer surgery, while increasing the incidence of perioperative complications, with data showing an overall complication rate of 13-38% after jejunostomy, and 0-3% of patients experiencing serious complications that require management, and therefore is not routinely recommended.

In summary, the final conclusion of the current clinical studies on whether to adopt jejunostomy after esophageal cancer resection is still controversial. Meanwhile, to the best of our knowledge, no study has yet examined the circumstances under which the option of performing a jejunostomy may be beneficial to patients. Therefore, in this study, on the basis of analyzing the relationship between the routine placement of jejunostomy tubes and tumor outcomes, and investigating whether jejunostomy brings benefits to patients after esophageal cancer surgery, we propose to conduct subgroup analyses of OS to clarify whether it may bring clear benefits to patients under certain circumstances, so as to guide clinicians to choose to perform this procedure in an appropriate manner.