Safety and cost-benefit analysis of patients without gastric tube after thoracolaparoscopic esophagectomy: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YIN Yuanyuan ¹ , ZHENG E ¹ , LI Huanhuan ² ,  YANG Mei ¹ , YAO Li ¹ , ZHAO Chunlin ¹

1. West China School of Nursing, Sichuan University, Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610000, P. R. China;
2. West China School of Nursing, Sichuan University, Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610000,P. R. China;

Corresponding?author：

YANG Mei, Email: yangmei69@126.com

Keywords：

Thoracolaparoscopy; esophageal cancer surgery; indwelling gastric tube; cost-benefit

DOI：

10.7507/1007-4848.202209063

Video：

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Objective To compare the safety and comfort of patients with or without postoperative gastric tube placement after esophageal cancer surgery, and analyze the cost and nursing time of gastric tube placement. Methods The patients with esophageal cancer undergoing minimally invasive surgery in West China Hospital of Sichuan University in 2021 were enrolled. The patients were divided into a gastric tube indwelling group and a non gastric tube indwelling group according to whether the gastric tube was indwelled after the operation. The safety and comfort indicators of the two groups were compared. Results A total of 130 patients were enrolled. There were 66 patients in the gastric tube indwelling group, including 53 males and 13 females, aged 61.80±9.05 years and 64 patients in the non gastric tube indwelling group, including 55 males and 9 females, aged 64.47±8.00 years. Six patients in the non gastric tube indwelling group needed to place gastric tube 1 to 3 days after the operation due to their condition. There was no statistical difference in the incidence of postoperative complications between the two groups (P>0.05). The subjective comfort of patients in the gastric tube indwelling group was significantly lower than that in the non gastric tube indwelling group (P<0.001), and the incidence of foreign body sensation in the throat of patients in the gastric tube indwelling group was higher than that in the non gastric tube indwelling group (P<0.001). The average nursing time in the gastric tube indwelling group was about 59.58 minutes, and the average cost of gastric tube materials and nursing was 378.24 yuan per patient. Conclusion No gastric tube used after operation for appropriate esophageal cancer patients will not increase the incidence of postoperative complications (pulmonary infection, anastomotic leakage, chylothorax), but can increase the comfort of patients, save cost and reduce nursing workload, which is safe, feasible and economical.

Citation： YIN Yuanyuan, ZHENG E, LI Huanhuan, YANG Mei, YAO Li, ZHAO Chunlin. Safety and cost-benefit analysis of patients without gastric tube after thoracolaparoscopic esophagectomy: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 728-732. doi: 10.7507/1007-4848.202209063 Copy

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2.	Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: Analysis of period and birth cohort effects on recent trends. Ann Oncol, 2012, 23(12): 3155-3162.
3.	劉宇英, 魏君麗, 江柔, 等. 食管癌的流行病學及篩查研究進展. 中華疾病控制雜志, 2022, 26(7): 839-844.
4.	唐德榮, 嵇建, 王前偉, 等. 胸腹腔鏡食管癌根治術后放置胃管和無胃管對并發癥的影響. 臨床外科雜志, 2021, 29(6): 538-541.
5.	Mangano A, Marciano L. One-day nasogastric tube decompression after distal gastrectomy: A prospective randomized study. Surg Today, 2018, 48(1): 127.
6.	Gaignard E, Bergeat D, Courtin-Tanguy L, et al. Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary? Langenbecks Arch Surg, 2018, 403(5): 573-580.
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9.	Weijs TJ, Kumagai K, Berkelmans GH, et al. Nasogastric decompression following esophagectomy: A systematic literature review and meta-analysis. Dis Esophagus, 2017, 30(3): 1-8.
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11.	李印. "免管免禁"食管癌外科模式的歷史、現狀與未來. 中華胸部外科電子雜志, 2020, 7(3): 135-139.
12.	Li Y, Liu Z, Liu G, et al. Impact on short-term complications of early oral feeding in patients with esophageal cancer after esophagectomy. Nutr Cancer, 2021, 73(4): 609-616.
13.	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.
14.	楊璐霄, 何亮, 張加鑫, 等. 腹腔鏡輔助胃癌根治術不留置胃管臨床研究. 中國實用外科雜志, 2020, 40(4): 461-464.
15.	孟祥寧. 腹腔鏡輔助胃癌根治術不留置胃管對縮短術后住院時間及降低肺部并發癥發生率影響研究. 中國全科醫學, 2021, 24(S1): 46-48.
16.	Jordan EA, Moore SC. Enteral nutrition in critically ill adults: Literature review of protocols. Nurs Crit Care, 2020, 25(1): 24-30.
17.	Sakaguchi T, Hirata A, Kashiwase K, et al. Relationship of central venous pressure to body fluid volume status and its prognostic implication in patients with acute decompensated heart failure. J Card Fail, 2020, 26(1): 15-23.
18.	陳煌, 鄧小玲, 李秋燕, 等. 住院病人非計劃性拔管風險評估體系的構建. 護理研究, 2019, 33(14): 2404-2409.
19.	夏云, 楊瑩, 徐佳英, 等. 留置鼻膽管患者非計劃性拔管的影響因素分析. 中華現代護理雜志, 2019, 25(27): 3501-3504.
20.	Di Palma LDV, Mello GFSE, Granados CL, et al. Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients. Endosc Int Open, 2017, 5(7): E630-E634.
21.	Sakatoku Y, Fukaya M, Fujieda H, et al. Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer. Surg Case Rep, 2017, 3(1): 90.
22.	吳茜, 周姝, 萬文潔, 等. 留置鼻膽管對患者生理舒適度的影響和相關因素分析. 中華護理雜志, 2012, 47(11): 1017-1019.
23.	金環, 夏家紅, 楊曉霞, 等. 患者安全目標: 管路安全影響因素與管理策略. 中國衛生質量管理, 2020, 27(6): 9-12.
24.	肖鑫, 欒思源, 楊玉賞, 等. 錐形管狀胃聯合頸部端端分層吻合在胸腹腔鏡食管癌切除術中的應用價值. 中華消化外科雜志, 2019, 18(6): 542-548.

1. 劉宗超, 李哲軒, 張陽, 等. 2020全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2021, 7(2): 1-13.
2. Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: Analysis of period and birth cohort effects on recent trends. Ann Oncol, 2012, 23(12): 3155-3162.
3. 劉宇英, 魏君麗, 江柔, 等. 食管癌的流行病學及篩查研究進展. 中華疾病控制雜志, 2022, 26(7): 839-844.
4. 唐德榮, 嵇建, 王前偉, 等. 胸腹腔鏡食管癌根治術后放置胃管和無胃管對并發癥的影響. 臨床外科雜志, 2021, 29(6): 538-541.
5. Mangano A, Marciano L. One-day nasogastric tube decompression after distal gastrectomy: A prospective randomized study. Surg Today, 2018, 48(1): 127.
6. Gaignard E, Bergeat D, Courtin-Tanguy L, et al. Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary? Langenbecks Arch Surg, 2018, 403(5): 573-580.
7. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 現代實用醫學, 2003, 15(7): 460-465.
8. Smeets BJJ, Luyer MDP. Nutritional interventions to improve recovery from postoperative ileus. Curr Opin Clin Nutr Metab Care, 2018, 21(5): 394-398.
9. Weijs TJ, Kumagai K, Berkelmans GH, et al. Nasogastric decompression following esophagectomy: A systematic literature review and meta-analysis. Dis Esophagus, 2017, 30(3): 1-8.
10. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg, 2017, 152(3): 292-298.
11. 李印. "免管免禁"食管癌外科模式的歷史、現狀與未來. 中華胸部外科電子雜志, 2020, 7(3): 135-139.
12. Li Y, Liu Z, Liu G, et al. Impact on short-term complications of early oral feeding in patients with esophageal cancer after esophagectomy. Nutr Cancer, 2021, 73(4): 609-616.
13. 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.
14. 楊璐霄, 何亮, 張加鑫, 等. 腹腔鏡輔助胃癌根治術不留置胃管臨床研究. 中國實用外科雜志, 2020, 40(4): 461-464.
15. 孟祥寧. 腹腔鏡輔助胃癌根治術不留置胃管對縮短術后住院時間及降低肺部并發癥發生率影響研究. 中國全科醫學, 2021, 24(S1): 46-48.
16. Jordan EA, Moore SC. Enteral nutrition in critically ill adults: Literature review of protocols. Nurs Crit Care, 2020, 25(1): 24-30.
17. Sakaguchi T, Hirata A, Kashiwase K, et al. Relationship of central venous pressure to body fluid volume status and its prognostic implication in patients with acute decompensated heart failure. J Card Fail, 2020, 26(1): 15-23.
18. 陳煌, 鄧小玲, 李秋燕, 等. 住院病人非計劃性拔管風險評估體系的構建. 護理研究, 2019, 33(14): 2404-2409.
19. 夏云, 楊瑩, 徐佳英, 等. 留置鼻膽管患者非計劃性拔管的影響因素分析. 中華現代護理雜志, 2019, 25(27): 3501-3504.
20. Di Palma LDV, Mello GFSE, Granados CL, et al. Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients. Endosc Int Open, 2017, 5(7): E630-E634.
21. Sakatoku Y, Fukaya M, Fujieda H, et al. Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer. Surg Case Rep, 2017, 3(1): 90.
22. 吳茜, 周姝, 萬文潔, 等. 留置鼻膽管對患者生理舒適度的影響和相關因素分析. 中華護理雜志, 2012, 47(11): 1017-1019.
23. 金環, 夏家紅, 楊曉霞, 等. 患者安全目標: 管路安全影響因素與管理策略. 中國衛生質量管理, 2020, 27(6): 9-12.
24. 肖鑫, 欒思源, 楊玉賞, 等. 錐形管狀胃聯合頸部端端分層吻合在胸腹腔鏡食管癌切除術中的應用價值. 中華消化外科雜志, 2019, 18(6): 542-548.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and cost-benefit analysis of patients without gastric tube after thoracolaparoscopic esophagectomy: A prospective cohort study

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