The necessity of gastrointestinal decompression after Ivor Lewis esophagectomy: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Ao ¹ , JIAO Zichen ¹ , XUE Tao ² ,  WANG Tao ¹

1. Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;
2. Department of Thoracic and Cardiovascular Surgery, Southeast University Affiliated Zhongda Hospital, Nanjing, 210009, P.R.China;

Corresponding author：

WANG Tao, Email: wangtao_pumc@live.cn

Keywords：

Esophageal cancer; surgery; gastrointestinal decompression; enhanced recovery after surgery; randomized controlled trial

DOI：

10.7507/1007-4848.201804040

Video：

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Objective To explore the feasibility and safety of non-gastrointestinal decompression after esophagectomy and the necessity of gastric tube or the time to remove gastric tube. Methods Thirty patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, were included in the trial from June to October 2017. The patients were randomly and equally assigned to a trial group (non-gastrointestinal decompression) or a control group (gastrointestinal decompression). There was no significant difference in age (P=1.000), sex (P=1.000), tumor location (P=0.732), pathological type (P=1.000), pathological stage (P=0.507), and operation time (P=0.674) between the two groups. The clinical effect between the two groups were compared. Results There was no statistical difference in incidences of anastomotic leakage (P=1.000), anastomotic bleeding (P=1.000), gastroesophageal reflux (P=1.000) between the two groups. And there was no statistical difference in time of the first flatus (P=0.629) and the first bowel movement (P=0.599) after operation between the two groups. Conclusion Without gastrointestinal decompression after Ivor Lewis esophagectomy does not increase the incidences of anastomotic leakage, anastomotic bleeding and gastroesophageal reflux, and has no significant effect on the recovery of gastrointestinal function. Without gastrointestinal decompression after Ivor Lewis esophagectomy is safe and feasible. Removing gastric tube on the second day after operation is reasonable and feasible.

Citation： YU Ao, JIAO Zichen, XUE Tao, WANG Tao. The necessity of gastrointestinal decompression after Ivor Lewis esophagectomy: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 860-864. doi: 10.7507/1007-4848.201804040 Copy

1.	陈万青, 郑荣寿, 张思维, 等. 2013 年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2017, 26(1): 1-7.
2.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
3.	Lewis I. The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third. Br J Surg, 1946, 34: 18-31.
4.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
5.	Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
6.	Sun HB, Li Y, Liu XB, et al. Early oral feeding following McKeown Minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial. Ann Surg, 2018, 267(3): 435-442.
7.	陈钶, 牟一平, 徐晓武, 等. 胃癌根治术后常规留置胃管必要性的荟萃分析. 中华医学杂志, 2012, 92(26): 1841-1844.
8.	Shackcloth MJ, Mccarron E, Kendall J, et al. Randomized clinical trial to determine the effect of nasogastric drainage on tracheal acid aspiration following oesophagectomy. Br J Surg, 2006, 93(5): 547-552.
9.	Sato T, Takayama T, So K, et al. Is retention of a nasogastric tube after esophagectomy a risk factor for postoperative respiratory tract infection? J Infect Chemother, 2007, 13(2): 109-113.
10.	王总飞, 张瑞祥, 刘先本, 等. 不常规经鼻胃肠减压在食管癌腔镜手术中应用的可行性研究. 中国胸心血管外科临床杂志, 2014, 21(4): 494-497.
11.	Daryaei P, Vaghef Davari F, Mir M, et al. Omission of nasogastric tube application in postoperative care of esophagectomy. World J Surg, 2009, 33(4): 773-777.
12.	Mistry RC, Vijayabhaskar R, Karimundackal G, et al. Effect of short-term vs prolonged nasogastric decompression on major postesophagectomy complications: a parallel-group, randomized trial. Arch Surg, 2012, 147(8): 747-751.
13.	Sun HB, Liu XB, Zhang RX, et al. Early oral feeding following thoracolaparoscopic oesophagectomy for oesophageal cancer. Eur J Cardiothorac Surg, 2015, 47(2): 227-233.
14.	Koukouras D, Mastronikolis NS, Tzoracoleftherakis E, et al. The role of nasogastric tube after elective abdominal surgery. Clin Ter, 2001, 152(4): 241-244.
15.	李印, 孙海波. 食管癌加速康复外科治疗的进展及展望. 中华胸部外科电子杂志, 2017, 4(3): 140-148.
16.	Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2009, 22(2): 119-126.
17.	Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Immediate postoperative oral nutrition following esophagectomy: A multicenter clinical trial. Ann Thorac Surg, 2016, 102(4): 1141-1148.

1. 陈万青, 郑荣寿, 张思维, 等. 2013 年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2017, 26(1): 1-7.
2. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
3. Lewis I. The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third. Br J Surg, 1946, 34: 18-31.
4. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
5. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
6. Sun HB, Li Y, Liu XB, et al. Early oral feeding following McKeown Minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial. Ann Surg, 2018, 267(3): 435-442.
7. 陈钶, 牟一平, 徐晓武, 等. 胃癌根治术后常规留置胃管必要性的荟萃分析. 中华医学杂志, 2012, 92(26): 1841-1844.
8. Shackcloth MJ, Mccarron E, Kendall J, et al. Randomized clinical trial to determine the effect of nasogastric drainage on tracheal acid aspiration following oesophagectomy. Br J Surg, 2006, 93(5): 547-552.
9. Sato T, Takayama T, So K, et al. Is retention of a nasogastric tube after esophagectomy a risk factor for postoperative respiratory tract infection? J Infect Chemother, 2007, 13(2): 109-113.
10. 王总飞, 张瑞祥, 刘先本, 等. 不常规经鼻胃肠减压在食管癌腔镜手术中应用的可行性研究. 中国胸心血管外科临床杂志, 2014, 21(4): 494-497.
11. Daryaei P, Vaghef Davari F, Mir M, et al. Omission of nasogastric tube application in postoperative care of esophagectomy. World J Surg, 2009, 33(4): 773-777.
12. Mistry RC, Vijayabhaskar R, Karimundackal G, et al. Effect of short-term vs prolonged nasogastric decompression on major postesophagectomy complications: a parallel-group, randomized trial. Arch Surg, 2012, 147(8): 747-751.
13. Sun HB, Liu XB, Zhang RX, et al. Early oral feeding following thoracolaparoscopic oesophagectomy for oesophageal cancer. Eur J Cardiothorac Surg, 2015, 47(2): 227-233.
14. Koukouras D, Mastronikolis NS, Tzoracoleftherakis E, et al. The role of nasogastric tube after elective abdominal surgery. Clin Ter, 2001, 152(4): 241-244.
15. 李印, 孙海波. 食管癌加速康复外科治疗的进展及展望. 中华胸部外科电子杂志, 2017, 4(3): 140-148.
16. Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2009, 22(2): 119-126.
17. Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Immediate postoperative oral nutrition following esophagectomy: A multicenter clinical trial. Ann Thorac Surg, 2016, 102(4): 1141-1148.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The necessity of gastrointestinal decompression after Ivor Lewis esophagectomy: A randomized controlled trial

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