scholarly journals Early oral nutrition plays an active role in enhanced recovery after minimally invasive esophagectomy

2017 ◽  
Vol 9 (10) ◽  
pp. 3598-3602 ◽  
Author(s):  
Kazuo Koyanagi ◽  
Yuji Tachimori
Keyword(s):  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Active Role ◽  
Oral Nutrition ◽  
Invasive Esophagectomy

scholarly journals Impact of nasogastric decompression on gastric tube size after McKeown minimally invasive esophagectomy: A retrospective controlled cohort study

2021 ◽  
Author(s):  
Duo Jiang ◽  
Xian-Ben Liu ◽  
Wen-Qun Xing ◽  
Pei-Nan Chen ◽  
Shao-Kang Feng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Tube Size ◽  
Invasive Esophagectomy ◽  
Chest X Ray ◽  
The Right ◽  
The Impact ◽  
Nasogastric Decompression

Abstract Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE). Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identified for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0–34.7] vs. 0 [0–22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0–31.7] vs. 18.0 [0–25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien–Dindo（CD）≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This finding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest X-ray examination.

scholarly journals ENHANCED RECOVERY PATHWAYS (ERAS) IMPLEMENTATION IN MINIMALLY INVASIVE ESOPHAGECTOMY; AN EARLY EXPERIENCE

2021 ◽  
Vol 71 (6) ◽  
pp. 2082-86
Author(s):  
Aaishah Riaz ◽  
Bilal Umair ◽  
Asif Asghar ◽  
Muhammad Imtiaz ◽  
Raheel Khan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Outcomes ◽  
Conventional Group ◽  
Invasive Esophagectomy ◽  
Icu Stay ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Objective: To evaluate the impact of enhanced recovery pathways (ERAS) on hospital stay and postoperative outcomes in patients undergoing minimally invasive esophagectomy in comparison to conventional pathway. Study Design: Quasi experimental study. Place and Duration of Study: Thoracic Surgery Department, Combined Military Hospital Rawalpindi Pakistan, from Jul 2018 to Mar 2020. Methodology: A total of 80 patients who underwent minimally invasive esophagectomy were divided in two groups. Group A underwent ERAS pathway and group B underwent conventional pathway. Both groups were compared for demographic characteristics, mean ICU stay, length of hospital stay, commencement of oral intake, and time of chest drain removal, readmission rates, postoperative morbidity and mortality. Results: There was no significant difference in age, gender and diagnostic indication among both groups. ERAS group was found to have shorter mean ICU stay (1.18 ± 0.55 vs 2.06 ± 1.10 days p<0.012), shorter hospital stay (7.50 ± 1.23 vs 11.6 ± 3.65 days, p<.001), earlier commencement of oral feeding (4.30 ± 1.41 vs 9.10 ± 4.26 days, p<0.001) and early removal of chest drains (3.22 ± vs 4.11 ± 1.52 p<0.001); when compared to conventional group. Overall morbidity in ERAS group was 50 (40%) versus 65% (81.25%) in conventional group. Mortality was same in both groups (2.5%). There was no readmission in ERAS group. Conclusion: ERAS in minimally invasive esophagectomy is safe and has positive impact on postoperative outcomes with marked reduction in overall morbidity in comparison to conventional regime. Results can be enhanced by ensuring better compliance to its.......

scholarly journals Risk Factors for Failure of Direct Oral Feeding following a Totally Minimally Invasive Esophagectomy

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3616
Author(s):  
Henricus J.B. Janssen ◽  
Amaia Gantxegi ◽  
Laura F.C. Fransen ◽  
Grard A.P. Nieuwenhuijzen ◽  
Misha D.P. Luyer
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Oral Feeding ◽  
Invasive Esophagectomy ◽  
Female Sex ◽  
Preoperative Risk Factors

Recently, it has been shown that directly starting oral feeding (DOF) from postoperative day one (POD1) after a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) can further improve postoperative outcomes. However, in some patients, tube feeding by a preemptively placed jejunostomy is necessary. This single-center cohort study investigated risk factors associated with failure of DOF in patients that underwent a MIE-IL between October 2015 and April 2021. A total of 165 patients underwent a MIE-IL, in which DOF was implemented in the enhanced recovery after surgery program. Of these, 70.3% (n = 116) successfully followed the nutritional protocol. In patients in which tube feeding was needed (29.7%; n = 49), female sex (compared to male) (OR 3.5 (95% CI 1.5–8.1)) and higher ASA scores (III + IV versus II) (OR 2.2 (95% CI 1.0–4.8)) were independently associated with failure of DOF for any cause. In case of failure, this was either due to a postoperative complication (n = 31, 18.8%) or insufficient caloric intake on POD5 (n = 18, 10.9%). In the subgroup of patients with complications, higher ASA scores (OR 2.8 (95% CI 1.2–6.8)) and histological subtypes (squamous-cell carcinoma versus adenocarcinoma and undifferentiated) (OR 5.2 (95% CI 1.8–15.1)) were identified as independent risk factors. In the subgroup of patients with insufficient caloric intake, female sex was identified as a risk factor (OR 5.8 (95% CI 2.0–16.8)). Jejunostomy-related complications occurred in 17 patients (10.3%). In patients with preoperative risk factors, preemptively placing a jejunostomy may be considered to ensure that nutritional goals are met.

PS02.001: IMPLICATIONS OF JEJEUNOSTOMY OMISSION IN COMBINATION WITH EARLY FEEDING IN A MINIMALLY INVASIVE ESOPHAGECTOMY COHORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 119-120
Author(s):  
Paul Carroll ◽  
Frances Allison ◽  
Jonathan Yeung ◽  
Gail Darling
Keyword(s):  
Weight Loss ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Recovery Period ◽  
Oral Feeding ◽  
Oral Nutrition ◽  
Invasive Esophagectomy ◽  
Post Surgery ◽  
Significant Difference ◽  
One Year

Abstract Background Early oral feeding in esophagectomy is recognised as safe in esophagectomy. Typically, enteral feeding has been used in combination to avoid weight loss in the recovery period post surgery. Recently, avoidance of jejeunal feeding has been shown to be efficacious with respect to nutritional safety over one year post surgery. In Toronto, jejeunostomy insertion is routinely omitted in our minimally invasive esophagectomy practice. Methods This study sought to determine the nutritional impact this practice has by determining the examining a retrospective cohort before and after the practice change in 2016. Only patients with complete weight measurement follow up to 1 year were incorporated. Data displayed as median and interquartile range (IQR). Results The initial results analysis consists of a total of 63 patients (n = 38 with feeding Jej (FJ) and n = 25 without (NFJ). Median BMI at surgery was 26 kg/m2 (23.1–30.5) with no differences between the groups identified: FJ BMI 25.9 (23–29.4) vs NFJ 26.8(23.9–32.2). Length of stay was 10 days in both groups. At one year, BMI was 23.4 (20.6–26.0) with no difference between the groups, FJ 22.4 (20.6–25.9) vs 23.4 (20.9- 27.7), P = 0.798. Median weight loss at 1 year was 11.2kg (9.1%). More weight loss was identified in the NFJ group in the 1st month, 4kg (1.9–5.1) vs 7kg (4.5–10.4) (P = 0.035) but subsequent intervals demonstrated no significant difference. Readmissions within one year were higher in the FJ group (n = 10, of which 2 needed operative intervention for jejeunostomy site issues), as compared to a single admission in the NFJ group for a para-conduit hernia repair. Conclusion Early commencement of oral nutrition in combination with the omission of feeding jejeunostomy insertion has no prolonged nutritional impact after the 1st month. Overall, Body mass index is reduced in esophagectomy patients over the first year irrespective of feeding approach. Disclosure All authors have declared no conflicts of interest.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

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