Pre-therapy Laparoscopic Jejunostomy Provides Safe, Reliable Nutrition for Trimodality GEJ Cancer Care

Abstract

Background: Patients with locally advanced GEJ cancer may have severe obstruction and irreversible malnutrition requiring intervention such as TPN, stenting, or enteral access. Laparoscopic jejunostomy (LJ) is a reliable method of supplementing nutrition but is not widely used for fear of complications. At our institution we place LJ tubes preoperatively in such patients and aimed to evaluate their effectiveness. Methods: A retrospective review of patients undergoing neoadjuvant chemo-radiation and laparoscopic transhiatal esophagectomy (LTHE) from 2013 to 2022 was performed. Nutritional markers, weight, and height were recorded, LJ associated complications were recorded from placement time to removal. Thirty-day complications after LTHE were recorded using Clavien-Dindo classification. Results: Of 165 patients who underwent LTHE, twenty patients (12.1%) had LJ placement prior to neoadjuvant therapy due to obstructive symptoms and a median [IQR] weight loss of 13.6 kg [9.07, 16.74] despite dietary modification. LJs were placed a median [IQR] of 103.5 [93.3, 116.8] days prior to LTHE. Median [IQR] weight gain from LJ placement to LTHE was 2.09 kg [0.1, 5.03], P = .01. There were no major complications and 3 (15%) minor complications. There were no unplanned feeding interruptions greater than 48 hours or disruptions in neoadjuvant treatment. There was 1 (5%) 30-day complication after LTHE and there was no mortality. The median [IQR] hospital stay was 7 days [6.5, 9]. Conclusion: Jejunostomy feeding tube prior to neoadjuvant treatment consistently reverses weight loss with minor, manageable complications. Reliable pre-therapy nutrition in obstructed patients is associated with excellent esophagectomy results and should be considered the adjuvant nutritional treatment of choice.