Feasibility of Thoracolapascopic Esophagectomy without Routine Nasogastric Intubation for Patients with Esophageal Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGZong-fei , ZHANGRui-xiang , LIUXian-ben , SUNHai-bo , QINJian-jun ,  LIYin

Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, P. R. China;

Corresponding?author：

LIYin, Email: liyin825@aliyun.com

Keywords：

Nasogastric decompression; Esophagectomy; Anastomotic leak; Fast track surgery

DOI：

10.7507/1007-4848.20140140

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the feasibility of thoracolapascopic esophagectomy (TLE) without routine nasogastric (NG) intubation for patients with esophageal cancer (EC). Methods Clinical data of 78 EC patients under-going TLE without perioperative NG intubation in Affiliated Cancer Hospital of Zhengzhou University from January to September 2013 were analyzed (non-NG intubation group, including 48 male and 30 female patients with their age of 61.1± 8.5 years). Seventy-eight EC patients undergoing TLE with routine NG intubation for 7 days in 2012 were chosen as the control group (NG intubation group, including 50 male and 28 female patients with their age of 60.3±7.0 years). Operation time, postoperative morbidity, gastrointestinal functional recovery and patient discomfort were compared between the 2 groups. Results There was no in-hospital death in either groups. There was no statistic difference in the incidences of pulmonary infection (16.7% vs. 19.2%, P=0.676), anastomotic leakage (1.3% vs. 2.6%, P=0.560) or NG tube replacement (3.8% vs. 2.6%, P=0.649) between non-NG intubation group and NG intubation group. Time for recovery of intestinal motility (2.5± 1.1 days vs. 4.3±1.2 days, P < 0.05) and time for air evacuation (3.6±1.7 days vs. 5.8±2.1 days, P < 0.05) of non-NG intubation group were significantly shorter than those of NG intubation group. Ninety-seven percent of the patients (76/78)in NG intubation group had uncomfortable feeling including dry mouth and sore throat, and only 6% of the patients (5/78) in non-NG intubation group had nausea. All the patients were followed up for 3 months after discharge. There was no intestinal obstruction, pneumonia or late anastomotic leakage during follow-up. Conclusion TLE without routine NG intubation is safe and feasible for EC patients, which can not only reduce patients' discomfort but also improve early recovery of gastrointestinal function.

Citation： WANGZong-fei, ZHANGRui-xiang, LIUXian-ben, SUNHai-bo, QINJian-jun, LIYin. Feasibility of Thoracolapascopic Esophagectomy without Routine Nasogastric Intubation for Patients with Esophageal Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 494-497. doi: 10.7507/1007-4848.20140140 Copy

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2.	陳鈳, 牟一平, 徐曉武, 等.胃癌根治術后常規留置胃管必要性的薈萃分析.中華醫學雜志, 2012, 92 (26):1841-1844.
3.	于雪峰, 魏玉哲, 薛英威.留置胃管對胃癌患者圍手術期生活質量的影響.中華胃腸外科雜志, 2012, 15 (6):578-580.
4.	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.
5.	Weijs TJ, Ruurda JP, Nieuwenhuijzen GA, et al. Strategies to reduce pulmonary complications after esophagectomy. World J Gastroenterol, 2013, 19 (39):6509-6514.
6.	Kehlet H, Wilmore DW. Evidence-based surgical care and the evolu-tion of fast-track surgery. Ann Surg, 2008, 248 (2):189-198.
7.	Li C, Mei JW, Yan M, et al. Nasogastric decompression for radical gastrectomy for gastric cancer:a prospective randomized controlled study. Dig Surg, 2011, 28 (3):167-172.
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.	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.
10.	Mistry RC, Vijayabhaskar R, Karimundackal G, et al. Effect of short-term vs. prolonged nasogastric decompression on major posteso-phagectomy complications:a parallel-group, randomized trial. Arch Surg, 2012, 147 (8):747-751.
11.	Katsoulis IE, Livingstone JI, Sagor GR. Tube pharyngostomy:a simple method for prolonged intubation of the foregut following oesophagogastric surgery. Dig Surg, 2006, 23 (5-6):292-295.
12.	Rueth NM, Lee N, Groth SS, et al. Pharyngostomy tubes for gastric conduit decompression. J Thorac Cardiovasc Surg, 2010, 140 (2):373-376.
13.	Puri V, Hu Y, Guthrie T, et al. Retrograde jejunogastric decompre-ssion after esophagectomy is superior to nasogastric drainage. Ann Thorac Surg, 2011, 92 (2):499-503.
14.	Nguyen NT, Slone J, Wooldridge J, et al. Minimally invasive esop-hagectomy without the use of postoperative nasogastric tube decom-pression. Am Surg, 2009, 75 (10):929-931.

1. Bauer VP. The evidence against prophylactic nasogastric intubation and oral restriction. Clin Colon Rectal Surg, 2013, 26 (3):182-185.
2. 陳鈳, 牟一平, 徐曉武, 等.胃癌根治術后常規留置胃管必要性的薈萃分析.中華醫學雜志, 2012, 92 (26):1841-1844.
3. 于雪峰, 魏玉哲, 薛英威.留置胃管對胃癌患者圍手術期生活質量的影響.中華胃腸外科雜志, 2012, 15 (6):578-580.
4. 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.
5. Weijs TJ, Ruurda JP, Nieuwenhuijzen GA, et al. Strategies to reduce pulmonary complications after esophagectomy. World J Gastroenterol, 2013, 19 (39):6509-6514.
6. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolu-tion of fast-track surgery. Ann Surg, 2008, 248 (2):189-198.
7. Li C, Mei JW, Yan M, et al. Nasogastric decompression for radical gastrectomy for gastric cancer:a prospective randomized controlled study. Dig Surg, 2011, 28 (3):167-172.
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. 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.
10. Mistry RC, Vijayabhaskar R, Karimundackal G, et al. Effect of short-term vs. prolonged nasogastric decompression on major posteso-phagectomy complications:a parallel-group, randomized trial. Arch Surg, 2012, 147 (8):747-751.
11. Katsoulis IE, Livingstone JI, Sagor GR. Tube pharyngostomy:a simple method for prolonged intubation of the foregut following oesophagogastric surgery. Dig Surg, 2006, 23 (5-6):292-295.
12. Rueth NM, Lee N, Groth SS, et al. Pharyngostomy tubes for gastric conduit decompression. J Thorac Cardiovasc Surg, 2010, 140 (2):373-376.
13. Puri V, Hu Y, Guthrie T, et al. Retrograde jejunogastric decompre-ssion after esophagectomy is superior to nasogastric drainage. Ann Thorac Surg, 2011, 92 (2):499-503.
14. Nguyen NT, Slone J, Wooldridge J, et al. Minimally invasive esop-hagectomy without the use of postoperative nasogastric tube decom-pression. Am Surg, 2009, 75 (10):929-931.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Feasibility of Thoracolapascopic Esophagectomy without Routine Nasogastric Intubation for Patients with Esophageal Cancer

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