Routine postoperative nasogastric or nasojejunal tube placement may be unnecessary after gastric resection

Abstract

Objectives: The purpose of this study was to investigate the effects of not using routine nasogastric (NG) or nasojejunal (NJ) tubes on postoperative complications in gastric cancer patients undergoing resection.

Methods: This study includes 250 patients who underwent gastric resection diagnosed with gastric adenocarcinoma between November 2011 and December 2021. The patients were divided into two groups: those who routinely use NG or NJ tube in the early postoperative period and those who do not. Postoperative complications and length of hospital stay were compared between the two groups.

Results: Demographic, surgical, and histopathological characteristics were similar between the two groups. Oral feeding was started earlier in the non- NG or NJ tube group. There was no difference between the two groups regarding the length of hospital stay (p = 0.065). Severe postoperative complications (Clavien Dindo ≥ 3) were significantly lower in patients who did not use a nasogastric or nasojejunal tube (p = 0.001). Two patients in the NG/NJ tube group and one in the non-NG/NJ tube group developed anastomotic leakage.

Conclusions: According to the results of our study, routine NG or NJ tube use does not reduce postoperative severe complications or length of hospital stay.

Keywords

• Gastric adenocarcinoma
• gastric resection
• nasogastric or nasojejunal tube
• postoperative complications

References

1. 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
2. 2. Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today 2020;50:3-11. /
3. 3. Pacelli F, Rosa F, Marrelli D, Morgagni P, Framarini M, Cristadoro L, et al. Naso-gastric or naso-jejunal decompression after partial distal gastrectomy for gastric cancer. Final results of a multicenter prospective randomized trial. Gastric Cancer 2014;17:725-32.
4. 4. Chen CJ, Liu TP, Yu JC, Hsua S Der, Hsieh TY, Chu HC, et al. Roux-en-Y reconstruction does not require gastric decompression after radical distal gastrectomy. World J Gastroenterol 2012;18:251-6.
5. 5. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 20212021;24:1-21.
6. 6. AJCC Cancer Staging Manual. Amin MB, Edge SB, Greene FL, et al. (eds), Springer Cham, 2017.
7. 7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
8. 8. Wang Q, Wu Z, Shi J, Hou S, Shan F, Li S, et al. Omitting nasogastric tube placement after gastrectomy does not enhance postoperative recovery: a propensity score matched analysis. Langenbeck’s Arch Surg 2022;407;113-22.

9. 9. Sanaie S, Mahmoodpoor A, Najafi M. Nasogastric tube insertion in anaesthetized patients: a comprehensive review. Anaesthesiol Intensive Ther 2017;49:57-65.
10. 10. Bergeat D, Merdrignac A, Robin F, Gaignard E, Rayar M, Meunier B, et al. Nasogastric decompression vs no decompression after pancreaticoduodenectomy: the Randomized Clinical IPOD Trial. JAMA Surg 2020;155:e202291.
11. 11. Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous ascites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol 2018;6:105-13.
12. 12. Lu J, Wei ZQ, Huang CM, Zheng CH, Li P, Xie JW, et al. Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: results from a large population-based sample. World J Gastroenterol 2015;21:2425-32.
13. 13. Kuboki S, Shimizu H, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, et al. Chylous ascites after hepatopancreatobiliary surgery. Br J Surg 2013;100:522-7.
14. 14. Doglietto GB, Papa V, Tortorelli AP, Bossola M, Covino M, Pacelli F. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial. Arch Surg. 2004;139:1309-13.
15. 15. Li C, Mei JW, Yan M, Chen MM, Yao XX, Yang QM, et al. Nasogastric decompression for radical gastrectomy for gastric cancer: a prospective randomized controlled study. Dig Surg 2011;28:167-72.
16. 16. Hur H, Kim SG, Shim JH, Song KY, Kim W, Park CH, et al. Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery 2011;149:561-8.
17. 17. Wang D, Li T, Yu J, Hu Y, Liu H, Li G. Is nasogastric or nasojejunal decompression necessary following gastrectomy for gastric cancer? A systematic review and meta-analysis of randomised controlled trials. J Gastrointest Surg 2015;19:195-204.