Routine jejunostomy feeding after esophagectomy reduces early weight loss: a cohort study.

PURPOSE: Jejunostomy feeding tubes are commonly used during esophagectomy to provide postoperative nutritional support, but their impact on clinical outcomes remains uncertain. METHODS: This retrospective study included 507 patients who underwent esophagectomy for esophageal cancer at the Northern Oesophagogastric Unit between 2012 and 2014 and 2016-2019. Routine postoperative jejunostomy feeding was introduced in 2015. Outcomes measured were percentage weight change at 2, 6, 12, and 24 weeks postoperatively, length of hospital stay, weight loss in patients with major complications (Clavien-Dindo > 3), and long-term survival. RESULTS: Of the 507 patients, 290 received routine jejunostomy feeding and 217 did not. Jejunostomy-fed patients experienced significantly less weight loss at all measured time points, with weight loss at 2 weeks of 3.22% versus 7.24% (p < 0.001), at 6 weeks of 3.28% versus 8.30% (p < 0.001), at 3 months of 5.49% versus 10.38% (p < 0.001), and at 6 months of 6.89% versus 11.46% (p = 0.006). The greatest benefit was observed in patients receiving neoadjuvant chemotherapy followed by surgery, with the most pronounced difference at 3 months (5.23% vs. 11.63%). Median hospital stay was shorter in the jejunostomy group (11 versus 15 days), and long-term survival tended to be higher among jejunostomy-fed patients, although this did not reach statistical significance, although there was no significant difference in weight loss among patients with major complications. CONCLUSION: Routine postoperative jejunostomy feeding significantly reduces early postoperative weight loss after esophagectomy, particularly in patients receiving neoadjuvant chemotherapy. These benefits diminish by six months. Jejunostomy feeding may also shorten hospital stay and could be associated with improved long-term survival.