224. PURSUING ERAS POST-OESOPHAGECTOMY WITHOUT ENTERIC FEEDING TUBES: A 12 YEAR SINGLE CENTRE EXPERIENCE

Abstract

Abstract Early feeding post oesophagectomy is encouraged. Surgical outcomes from different routes of feeding be it oral, via nasoenteral or jejunostomy tubes remains debatable due to ERAS protocol variations. We present our outcomes from our single regional centre where oesophagectomies are completed without the insertion of nasoenteric or feeding jejunostomy tubes, and therefore oral intake being the sole route of post-operative nutrition. A retrospective study employed an electronic database of elective Ivor Lewis oesophagectomies from April 2009 to December 2021 at a tertiary upper gastrointestinal cancer centre in the United Kingdom. All patients without nasoenteric or jejunostomy tubes were included in the study, as this is the routine practice. Our practice involves a gradual increase in oral fluids from day 0 to 4, with supplementary intravenous fluid. We introduce a soft diet from the 5th post-operative day. We evaluated patient outcomes using the Clavien-Dindo grade (CDG). Primary outcomes were anastomotic leaks, length of stay, chyle leaks, and 30- and 90-day mortality. 578 Ivor Lewis oesophagectomies were peformed between 2009–2021 without any jejunostomies or nasoenteric tubes inserted. The median age was 63 years old (45–82) with M:F 1.8:1. The median length of stay (LOS) was 13 (3–148) days. Chyle leak was identified in 24 patients (4.2%) and of these 83.3% (n = 20) underwent surgical management with a mortality of 5% (n = 1). 16.7% (n = 4) chyle leaks were managed conservatively with a median LOS of 31 days (14–51), with no mortality. Anastomotic leaks were identified in 26 cases (4.5%), outcomes illustrated in the table. The 30- & 90-day mortality was 0.3% (n = 2) and 0.9% (n = 5). While the best route of feeding post oesophagectomy remains contentious and variable, we have shown that surgical outcomes from performing oesophagectomies without the insertion of any enteric feeding tubes is feasible and safe. While this challenges conventional paradigm, we demonstrate early oral intake using a well-defined ERAS protocol poses no increased risk of surgical complications and negates the additional risks inherent from jejunal tubes and artificial feeding.