Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on pos...Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.展开更多
Background:We previously observed decreasing resection rates of nonmetastatic gastric adenocarcinoma(GaC)in the US and some European countries.If and to what extent these trends affect the trends in overall survival(O...Background:We previously observed decreasing resection rates of nonmetastatic gastric adenocarcinoma(GaC)in the US and some European countries.If and to what extent these trends affect the trends in overall survival(OS)of patients with non-metastatic GaC at the population level remain unclear.This large international population-based cohort study aimed to assess the impact of the previously observed decreasing resection rates on multivariable-adjusted trends in the long-term OS of patients with non-metastatic GaC.Methods:Individual-level data of patients with non-metastatic GaC were obtained from the national cancer registries of the Netherlands,Belgium,Sweden,Norway,and Slovenia,and the US Surveillance,Epidemiology,and End Results database.We analyzed data for each country separately.Associations between year of diagnosis and OS were assessed using Cox proportional hazards regression model with adjustment for multiple prognostic variables,with and without including resection and chemotherapy as potential explanatory variables.Results:A total of 66,398 non-metastatic GaC patients diagnosed in 2003-2016 were analyzed,with an accumulated follow-up of 172,357 person-years.Without adjustment for resection,OS was improved only slightly in the US[hazard ratio(HR)_(per year)=0.99;HR_(≥vs.<2010)=0.96],and no improvement was observed in the investigated European countries,with OS even worsening in Sweden(HR_(per year)=1.03;HR_(≥vs.<2010)=1.17).After adjusting for resection,the increasing OS trend became stronger in the US(HR_(per year)=0.98;HR_(≥vs.<2010)=0.88),and the temporal trend became insignificant in Sweden.In Slovenia(HR_(per year)=0.99;HR_(≥vs.<2010)=0.92)and Norway(HR_(per year)=0.97;HR_(≥vs.<2010)=0.86),improved OS over time emerged after resection adjustment.Improved OS in patients undergoing resection was observed in the US,the Netherlands,and Norway.Adjustment for chemotherapy did not alter the observed associations.Stratified analyses by tumor location showedmostly similar resultswith the findings in all patients with non-metastatic GaCs regarding the associations between year of diagnosis and survival.Conclusions:OS of patients with non-metastatic GaC mostly did not improve in selected European countries and was even worsened in Sweden,while it was slightly increased in the US in the early 21st century.Progress in OS of patients with non-metastatic GaC seems to have been impeded to a large extent by decreasing rates of resection.展开更多
文摘Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.
文摘Background:We previously observed decreasing resection rates of nonmetastatic gastric adenocarcinoma(GaC)in the US and some European countries.If and to what extent these trends affect the trends in overall survival(OS)of patients with non-metastatic GaC at the population level remain unclear.This large international population-based cohort study aimed to assess the impact of the previously observed decreasing resection rates on multivariable-adjusted trends in the long-term OS of patients with non-metastatic GaC.Methods:Individual-level data of patients with non-metastatic GaC were obtained from the national cancer registries of the Netherlands,Belgium,Sweden,Norway,and Slovenia,and the US Surveillance,Epidemiology,and End Results database.We analyzed data for each country separately.Associations between year of diagnosis and OS were assessed using Cox proportional hazards regression model with adjustment for multiple prognostic variables,with and without including resection and chemotherapy as potential explanatory variables.Results:A total of 66,398 non-metastatic GaC patients diagnosed in 2003-2016 were analyzed,with an accumulated follow-up of 172,357 person-years.Without adjustment for resection,OS was improved only slightly in the US[hazard ratio(HR)_(per year)=0.99;HR_(≥vs.<2010)=0.96],and no improvement was observed in the investigated European countries,with OS even worsening in Sweden(HR_(per year)=1.03;HR_(≥vs.<2010)=1.17).After adjusting for resection,the increasing OS trend became stronger in the US(HR_(per year)=0.98;HR_(≥vs.<2010)=0.88),and the temporal trend became insignificant in Sweden.In Slovenia(HR_(per year)=0.99;HR_(≥vs.<2010)=0.92)and Norway(HR_(per year)=0.97;HR_(≥vs.<2010)=0.86),improved OS over time emerged after resection adjustment.Improved OS in patients undergoing resection was observed in the US,the Netherlands,and Norway.Adjustment for chemotherapy did not alter the observed associations.Stratified analyses by tumor location showedmostly similar resultswith the findings in all patients with non-metastatic GaCs regarding the associations between year of diagnosis and survival.Conclusions:OS of patients with non-metastatic GaC mostly did not improve in selected European countries and was even worsened in Sweden,while it was slightly increased in the US in the early 21st century.Progress in OS of patients with non-metastatic GaC seems to have been impeded to a large extent by decreasing rates of resection.
