Effect of routine jejunostomy tube insertion in esophagectomy: A systematic review and meta-analysis

Abstract

Background: Routine feeding jejunostomy tube post esophagectomy is being revaluated because of its associated postoperative complications. We performed a systematic review and meta-analysis to evaluate the effect of routine feeding jejunostomy tube insertion on mortality and postesophagectomy outcomes.

Methods: Electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) were queried through December 2020. Included studies compared esophagectomy with and without postoperative feeding jejunostomy. The primary outcome was 30-day mortality. Secondary outcomes included readmission rate, length of stay, postoperative complications (sepsis, pneumonia, chyle leakage, and anastomotic leakage), and duration of surgery. Random effects pairwise meta-analysis was used to compare groups, and the risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.

Results: The meta-analyses of 12 studies (2 randomized controlled trials, 10 observational) that enrolled 36,284 participants showed lower 30-day all-cause mortality in the jejunostomy tube group (risk ratio [RR] = 1.53 [95% CI, 1.37-1.70], P < .01; I² = 0%, P = .80). Duration of surgery favored the no jejunostomy group (mean difference = -37.18; 95% CI, -59.48 to -14.87; P < .01). However, the 2 groups were not different in incidence of anastomotic leakage (RR = 0.88; 95% CI, 0.61-1.28; P = .50), length of stay (mean difference = -0.22; 95% CI, -1.34-0.89; P = .69), readmission (RR = 0.97; 95% CI, 0.92-1.02; P = .20), chyle leakage (RR = 1.05; 95% CI, 0.34-3.27; P = .94), sepsis (RR = 1.20; 95% CI, 0.96-1.50; P = .11), pneumonia (RR = 0.88; 95% CI, 0.75-1.03; P = .11).

Conclusions: Feeding jejunostomy tube after esophagectomy might lead to lower 30-day all-cause mortality with no difference in common postesophagectomy complications. A routine insertion of a jejunostomy tube should be considered at the time of surgery for esophageal cancer resection.

Keywords: J-tube; esophagectomy; feeding jejunostomy; meta-analysis.