Risks and Benefits of Feeding Enterostomy Creation During Minimally Invasive Esophagectomy: A Propensity-Weighted Analysis Using the Japanese National Clinical Database

Abstract

Background

Feeding enterostomy is commonly created during minimally invasive esophagectomy (MIE); however, its short-term impact remains unclear.

Methods

We analyzed 19 054 patients who underwent MIE for esophageal or esophagogastric junction cancer during 2019–2022. Inverse probability of treatment weighting was applied to balance baseline characteristics, and G-computation was used to estimate adjusted risks and means and their differences. A secondary analysis was performed to compare gastrostomy and jejunostomy in retrosternal cases.

Results

Of 19 054 patients, 4599 (24.1%) received a feeding enterostomy. After adjustment, the primary outcome, postoperative bowel obstruction, did not differ significantly between enterostomy group and no-enterostomy group (+0.2%, p = 0.132). The enterostomy group demonstrated higher rates of reoperation (+2.5%, p < 0.001) and respiratory complications, including pneumonia (+2.5%, p < 0.001) and prolonged ventilation (+0.9%, p = 0.012), than the no-enterostomy group. Conversely, delayed gastric emptying (−0.9%, p < 0.001) and deep vein thrombosis (−0.4%, p = 0.028) occurred less frequently. Among 2723 patients who underwent retrosternal reconstruction with feeding enterostomy, jejunostomy was associated with a shorter operative time (−11.2 min, p = 0.025), whereas gastrostomy was associated with a 2.3-day shorter hospital stay than jejunostomy (p = 0.022). Bowel-related events were rare, and adjusted comparisons for these outcomes were not performed.

Conclusion

Feeding enterostomy during MIE may confer benefits (e.g., reduced delayed gastric emptying and deep vein thrombosis) but is also associated with increased postoperative complications. Routine or uniform placement of a feeding enterostomy should be avoided, and gastrostomy may be preferable in retrosternal reconstruction.