Short-term clinical outcomes of nasoduodenal tube versus feeding jejunostomy after minimally invasive esophagectomy: a retrospective cohort study with exploratory microbiome analysis

Background Esophagectomy remains an effective treatment for esophageal cancer but is associated with severe postoperative complications, in which nutritional status plays a critical role. The optimal route for enteral feeding remains uncertain. To address this uncertainty, we compared the short-term clinical outcomes of the two approaches and exploratorily analyzed the differences in gut microbiota.

Methods This retrospective cohort study enrolled patients who underwent minimally invasive esophagectomy (MIE) for esophageal squamous cell carcinoma (ESCC) between July 2018 and June 2021. Primary outcomes were surgery-related complications (including anastomotic leakage, anastomotic stenosis, pneumonia, respiratory failure, cardiac events, chylothorax, intestinal fistula and bowel obstruction) and catheterrelated outcomes (including occlusion, accidental removal, displacement and retention time). Baseline data were extracted from medical records. Propensity score matching (PSM) was applied to control for potential confounders. Intestinal fluid and fecal samples were collected after enteral nutrition for 16S ribosomal DNA (16S rDNA) sequencing.

Results After PSM, a total of 381 patients (nasoduodenal tube: 282; feeding jejunostomy: 153) was finally included. The feeding jejunostomy group exhibited a higher incidence of pneumonia (21.49% vs. 33.99%, P=0.007), respiratory failure (3.07% vs. 13.07%, P<0.001), anastomotic stenosis (1.32% vs. 5.23%, P=0.031) and bowel obstruction (0% vs. 2.16%, P=0.025). Nasoduodenal tube placement was associated with more accidental removal (13.16% vs. 0.65%, P<0.001) and catheter displacement (13.60% vs. 6.54%, P=0.029). The catheter retention time {37 [interquartile range (IQR):15-40] days vs. 39 [IQR:37-42] days, P<0.001} was also shorter in nasoduodenal tube group.

Conclusions In this study, nasoduodenal tube placement was associated with a higher incidence of catheter-related complications, whereas feeding jejunostomy was linked to more surgery-related complications. Nasoduodenal tube placement also showed potential functional advantages for the gut microbiome. However, future multi-center randomized controlled trials are still needed to minimize potential confounders and validate the differences between the two enteral nutrition routes.