Benefits of jejunostomy feeding in patients who underwent gastrectomy for cancer treatment

Table 1 Baseline demographic characteristics of the population, cohort N = 172, n (%)

Variables	J + (n = 60)	J - (n = 112)	P value
Age (years, mean ± SD)	69.4 ± 12.6	70.2 ± 11.2	0.65
Male	43 (71.7)	57 (50.9)	0.01a
H. pylori infection	11 (18.3)	13 (11.6)	0.25
Smoking	6 (10.2)	12 (10.8)	1
Medical background	40 (66.7)	77 (69.4)	0.73
Dementia	5 (8.3)	4 (3.6)	0.28
Stroke	6 (10)	7 (6.2)	0.38
AF	7 (11.7)	8 (7.2)	0.4
CAD	4 (6.7)	7 (6.2)	1
Heart failure	6 (10)	5 (4.5)	0.2
LEAD	4 (6.7)	7 (6.2)	1
Diabetes	15 (25)	28 (25)	1
Other cancer	12 (20)	18 (16.1)	0.53
Abdominal surgery	18 (30)	46 (41.1)	0.19
AC/APA	21 (35.6)	26 (23.9)	0.11
Corticoids/IT	1 (1.7)	2 (1.8)	1
WHO score
0	18 (38.3)	37 (38.9)	0.58
1	20 (42.6)	43 (45.3)
2	5 (10.5)	12 (12.6)
3	4 (8.5)	3 (3.2)

^aP < 0.05.

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. AC: Anticoagulant; AF: Atrial fibrillation; APA: Antiplatelet agent; CAD: Coronary artery disease; H. pylori: Helicobacter pylori; IT: Immunosuppressive therapy; LEAD: Lower-extremity artery disease; WHO: World Health Organization.

Table 2 Preoperative nutritional characteristics, cohort N = 172, n (%)

Variables	J + (n = 60)	J - (n = 112)	P value
Weight (kg, mean ± SD)	64 ± 12.9	66.7 ± 14.3	0.23
BMI (kg/m2, mean ± SD)	22.7 ± 4.6	24.2 ± 4.8	0.09
Weight loss (kg, mean ± SD)	12.2 ± 6.4	10.1 ± 4.3	0.15
Proportion weight loss (%, mean ± SD)	15.9 ± 8.5	13.9 ± 5.5	0.21
Duration of weight loss (months, mean ± SD)	3.9 ± 5.2	4.7 ± 4.3	0.52
Preoperatory albuminemia (g/L, mean ± SD)	32.3 ± 6.9	32.6 ± 8.6	0.87
Preoperatory prealbuminemia (g/L, mean ± SD)	0.19 ± 0.06	0.17 ± 0.05	0.3
PNI (mean ± SD)	41.2 ± 8.8	39.8 ± 12	0.74
PNI < 46	18 (54.5)	13 (81.2)	0.22
Undernutrition	21 (36.2)	34 (35.7)	1
Severe undernutrition	16 (28.1)	17 (17.9)	0.55

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. Continuous variables are expressed as the mean and standard deviation. Categorical variables are expressed as numbers and percentages. Weight loss is expressed as an absolute and a relative average value. PNI: Prognostic nutritional index; BMI: Body mass index.

Table 3 Tumour characteristics, cohort N = 172, n (%)

Variables	J + (n = 60)	J - (n = 112)	P value
Adenocarcinoma	47 (79.7)	87 (78.4)	1
Grade of differentiation
Good	5 (10.9)	7 (9)	0.76
Moderate	18 (39.1)	38 (48.7)	0.35
Poor	20 (43.5)	31 (39.7)	0.71
Contingent of independent cells	23 (38.3)	33 (30.3)	0.31
GIST	9 (15.5)	22 (20.2)	0.53
Low risk	1 (11.1)	8 (40)	0.2
Medium risk	1 (11.1)	3 (15)	1
High risk	7 (77.8)	9 (45)	0.13
Tumour ≤ 3 cm	10 (16.7)	20 (18.9)	0.84
T
0	0 (0)	3 (2.7)	0.036a
1	5 (8.3)	12 (10.7)
2	6 (10)	21 (18.8)
3	23 (38.8)	39 (34.8)
4	19 (31.7)	15 (13.4)
N0	18 (32.1)	31 (34.4)	0.86
M0	50 (90.9)	79 (84.9)	0.45
Clear margins	45 (75)	92 (84.4)	0.15
Vascular invasion	25 (43.1)	48 (44)	1
Perineural invasion	27 (46.6)	39 (36.1)	0.24

^aP < 0.05.

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. GIST: Gastrointestinal stromal tumor.

Table 4 Postoperative complications, cohort N = 172, n (%)

	J + (n = 60)	J - (n = 112)	P value
Global complications	15 (25)	41 (36.6)	0.12
Thromboembolic	2 (1.2)	4 (2.3)	1
Respiratory (other than aspiration pneumonia and thromboembolic)	0 (0)	6 (5.4)	0.09
Aspiration pneumonia	2 (3.3)	0 (0)	0.12
Haemorrhagic	1 (1.7)	6 (5.4)	0.42
Infectious	2 (1.2)	16 (9.3)	0.03a
Deep collection	2 (1.2)	3 (1.7)	1
Ileus	4 (2.3)	10 (5.8)	0.77
Occlusion	0 (0)	3 (1.7)	0.55
Fistula	2 (3.3)	6 (5.4)	0.71
Others	3 (1.7)	9 (5.2)	0.54
Renutrition syndrome	1 (0.6)	0 (0)	0.34
Probe obstruction	1 (0.6)	0 (0)	0.34
Abscess around the probe	1 (0.6)	0 (0)	0.34

^aP < 0.05.

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared.

Table 5 Length of stay, cohort N = 172, n (%)

Variables	J + (n = 60)	J - (n = 112)	P value
Total hospitalization (days, mean ± SD)	20.49 ± 9.32	16.45 ± 9.47	0.01a
Conventional	17.75 ± 8.50	14.06 ± 7.71	0.01a
Postoperative	18.13 ± 8.32	17.96 ± 12.52	0.71
PICU	1.65 ± 1.55	1.87 ± 3.61	0.68
ICU	0.84 ± 3.45	0.1 ± 0.71	0.11
CCU	0.07 ± 0.37	0.02 ± 0.19	0.33

^aP < 0.05.

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. PICU: Postoperative intensive care unit; ICU: Intensive care unit; CCU: Critical care unit.

Table 6 Postoperative nutritional characteristics

Variables	J +	J -	P value
Weight (kg, mean ± SD)	58.86 ± 11.8	56 ± 9.8	0.34
Weight loss (kg, mean ± SD)	5.74 ± 8.4	9.86 ± 7.5	0.07
Proportion weight loss (%, mean ± SD)	10.25 ± 8	14.19 ± 9.5	0.12
Albuminemia (g/L, mean ± SD)	31.4 ± 5.5	32.3 ± 10.9	0.8
Loss of albuminemia (g/L, mean ± SD)	7.2 ± 5.6	14.7 ± 12.7	0.15
Proportion albuminemia loss (%, mean ± SD)	20 ± 15.6	40 ± 33.1	0.16

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared.

Table 7 Subset analysis in partial gastrectomies, cohort N = 89, n (%)

	J + (n = 12)	J - (n = 77)	P value
Global complications	4 (33.3)	30 (38.9)	0.96
Thromboembolic	0 (0)	2 (2.6)	1
Respiratory (other than aspiration pneumonia and thromboembolic)	0 (0)	6 (7.8)	0.7
Aspiration pneumonia	1 (8.3)	0 (0)	0.28
Haemorrhagic	0 (0)	3 (3.9)	1
Infectious	0 (0)	10 (12.9)	0.4
Deep collection	0 (0)	2 (2.6)	1
Ileus	1 (8.3)	8 (10.4)	1
Occlusion	0 (0)	2 (2.6)	1
Fistula	1 (6.5)	5 (8.3)	1
Others	1 (8.3)	7 (9.1)	1
Renutrition syndrome	0 (0)	0 (0)	1
Probe obstruction	0 (0)	0 (0)	1
Abscess around the probe	1 (8.3)	0 (0)	0.28

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared.

Table 8 Subset analysis in total gastrectomies, cohort N = 74, n (%)

	J + (n = 48)	J - (n = 26)	P value
Global complications	11 (22.9)	7 (26.9)	0.92
Thromboembolic	2 (4.2)	1 (3.8)	1
Respiratory (other than aspiration pneumonia and thromboembolic)	0 (0)	0 (0)	1
Aspiration pneumonia	1 (2.1)	0 (0)	1
Haemorrhagic	1 (2.1)	1 (3.8)	1
Infectious	2 (4.2)	4 (15.4)	0.21
Deep collection	2 (4.2)	1 (3.8)	1
Ileus	3 (6.3)	1 (3.8)	1
Occlusion	0 (0)	0 (0)	1
Fistula	1 (2.1)	1 (3.8)	1
Others	2 (4.2)	2 (7.7)	0.92
Renutrition syndrome	1 (2.1)	0 (0)	1
Probe obstruction	1 (2.1)	0 (0)	1
Abscess around the probe	0 (0)	0 (0)	1

A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared.

Table 9 Multivariable analysis

Type of cohort	Variables	Age			Sex (M)			Dementia			H. pylori infection			Sroke			Heart failure			Atrial fibrillation			Severe undernutrition
	Estimates	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Entire cohort	Global complications	1	0.97-1.03	0.51	0.79	0.41-1.55	0.49	6.42	1.19-52.4	0.04a	1.74	0.67-4.45	0.25	0.26	0.03-1.26	0.14	0.66	0.12-2.88	0.61	0.6	0.13-2.16	0.47	1.28	0.61-2.64	0.52
	Thromboembolic	0.95	0.88-1.02	0.18	1.37	0.24-10.54	0.73	-	-	-	0.78	0.03-6.63	0.85	-	-	-	8.36	0.33-110.9	0.12	-	-	-	0.51	0.03-3.54	0.56
	Respiratory	1.05	0.96-1.16	0.33	0.36	0.04-2.1	0.27	7	0.21-113	0.19	4.15	0.42-32.3	0.17	-	-	-	1.47	0.05-16.94	0.78	1.94	0.09-16.88	0.59	0.2	0-2.05	0.27
	Aspiration pneumonia	1.17	0.93-1.77	0.28	2.13	0.05-603	0.7	12.79	0.12-863	0.21	2.34	0.01-102	0.66	-	-	-	12.1	0.11-760	0.21	-	-	-	0.31	0-17.5	0.61
	Haemorrhagic	0.99	0.93-1.06	0.8	0.51	0.1-2.41	0.39	-	-	-	1.34	0.07-9	0.8	-	-	-	-	-	-	-	-	-	1.11	0.15-5.5	0.91
	Infectious	0.99	0.95-1.04	0.69	0.53	0.19-1.48	0.23	9.75	1.03-88.8	0.04a	0.66	0.09-2.9	0.63	-	-	-	0.66	0.03-4.97	0.73	1.72	0.23-8.36	0.54	0.64	0.16-2.03	0.48
	Deep collection	1	0.92-1.09	0.92	0.13	0-1.03	0.09	-	-	-	-	-	-	-	-	-	13.84	0.4-488	0.11	-	-	-	3.21	0.44-26.99	0.24
	Ileus	1.03	0.98-1.09	0.22	1.05	0.33-3.47	0.94	-	-	-	1.36	0.19-5.94	0.71	-	-	-	0.87	0.04-6.01	0.91	1.68	0.22-8.16	0.56	2.06	0.62-6.48	0.22
	Occlusion	0.98	0.87-1.1	0.22	0.4	0.02-4.84	0.94	-	-	-	2.77	0.1-40.5	0.71	9.62	0.33-215.5	0.99	-	-	-	-	-	-	-	-	-
	Fistula	1.01	0.95-1.08	0.81	0.21	0.03-1	0.07	0.92	0.02-14.57	0.96	1.53	0.14-9.89	0.68	2.1	0.07-23.7	0.59	2.38	0.09-27.2	0.52	-	-	-	2.52	0.49-12.9	0.25
	Others	1.01	0.95-1.07	0.79	1.36	0.39-5.42	0.64	2.53	0.22-20.3	0.41	2.11	0.39-8.61	0.33	1.6	0.16-10.13	0.65	-	-	-	-	-	-	1.03	0.23-3.82	0.97
Partial gastrectomies	Global complications	1.02	0.98-1.07	0.34	0.8	0.29-2.17	0.66	-	-	-	4.41	0.93-25.3	0.07	0.53	0.03-4.15	0.59	1.11	0.13-7.9	0.92	0.61	0.08-3.3	0.59	0.86	0.29-2.4	0.77
	Thromboembolic	0.98	0.82-1.22	0.83	0.57	0.01-20.3	0.74	-	-	-	-	-	-	-	-	-	39.9	0.88-540	0.06	-	-	-	0.98	0.02-32.7	0.99
	Respiratory	1.03	0.93-1.15	0.63	0.38	0.04-2.8	0.37	4.27	0.12-72.3	0.33	7.56	0.61-96.3	0.09	-	-	-	2.39	0.07-46.7	0.57	3.92	0.16-49.8	0.31	0.09	0-1.18	0.14
	Aspiration pneumonia	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
	Haemorrhagic	1.01	0.91-1.14	0.86	2.03	0.17-47.1	0.58	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	2.03	0.17-47.1	0.99
	Infectious	1.1	0.98-1.17	0.17	0.8	0.17-3.57	0.77	11.3	0.91-271.8	0.07	0.39	0.01-4.33	0.53	-	-	-	0.98	0.03-11.3	0.99	1.43	0.06-12.1	0.77	0.56	0.08-2.88	0.515
	Deep collection	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
	Ileus	1.03	0.97-1.12	0.34	1.36	0.3-6.53	0.69	-	-	-	1.1	0.05-8.21	0.94	-	-	-	1.33	0.06-11.7	0.82	1.11	0.05-9.6	0.93	2.27	0.51-10.4	0.27
	Occlusion	0.98	0.82-1.22	0.85	0.49	0.01-16.38	0.67	-	-	-	-	-	-	17.8	0.52-929	0.09	-	-	-	-	-	-	-	-	-
	Fistula	1.02	0.94-1.16	0.63	0.07	0-0.74	0.07	0.29	0-12.11	0.56	6.96	0.39-137.9	0.17	16.35	0.42-702	0.1	2.07	0.04-45.9	0.66	-	-	-	4.51	0.53-54.47	0.18
	Others	1.01	0.93-1.1	0.8	1.72	0.29-13.95	0.57	2.81	0.16-31.48	0.43	6.41	0.85-43.91	0.05	3.53	0.28-31.38	0.27	-	-	-	-	-	-	0.67	0.07-4	0.68
Total gastrectomies	Global complications	0.98	0.93-1.03	0.38	0.73	0.22-2.52	0.61	-	-	-	0.73	0.1-3.62	0.72	-	-	-	-	-	-	1.01	0.05-8.95	0.99	2.3	0.62-8.4	0.2
	Thromboembolic	0.93	0.82-1.02	0.15	2.5	0.16-85.16	0.54	-	-	-	2.98	0.11-49.1	0.44	-	-	-	-	-	-	-	-	-	-	-	-
	Respiratory	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
	Aspiration pneumonia	1.11	0.91-1.63	0.46	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
	Haemorrhagic	1	0.89-1.16	0.95	0.42	0.01-11.99	0.57	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	3.17	0.12-86.87	0.43
	Infectious	0.93	0.84-1.00	0.08	0.28	0.03-1.77	0.19	-	-	-	0.84	0.03-8.17	0.89	-	-	-	-	-	-	10.75	0.33-309	0.14	0.85	0.04-8.44	0.9
	Deep collection	1	0.9-1.12	0.96	0.18	0.01-2.4	0.21	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	7.53	0.61-184.88	0.13
	Ileus	1.04	0.94-1.19	0.47	1.85	0.19-46.88	0.63	-	-	-	-	-	-	-	-	-	-	-	-	4.92	0.17-87.66	0.27	1.68	0.07-20.5	0.69
	Occlusion	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
	Fistula	0.93	0.82-1.04	0.24	0.64	0.02-20.36	0.78	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
	Others	1.02	0.94-1.13	0.62	0.38	0.04-3.54	0.37	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	1.04	0.05-9.63	0.97

^aP < 0.05.

H. pylori: Helicobacter pylori; OR: Odds ratio; M: Male.