273. EVALUATION OF THE RESULTS OF ‘TUBELESS’ ESOPHAGECTOMY IN PATIENTS WITH ESOPHAGEAL CANCER WITHIN AN ERAS PROTOCOL

Abstract

Abstract Classically, esophagectomy used to routinely left chest drains, as well as decompressive nasogastric tube (NGT) and feeding jejunostomy, making the postoperative period slower and more uncomfortable for patients. Our objective is to evaluate the results of not using tubes and drains (tubeless esophagectomy) in patients with esophageal cancer undergoing McKeown esophagectomy within an ERAS protocol in our center. Retrospective, descriptive and comparative study of two consecutive groups undergoing McKeown esophagectomy. The first group (P) included 25 patients with tubes and drains (April 2018–August 2019) and the second group (T) 25 patients undergoing tubeless esophagectomy (July 2020–December 2021). In group P all patients were left with thoracic drainage and jejunostomy and in selected cases abdominal drainage; no patient was left with NGT. In group T (‘TUBELESS’) no drains or NGT were placed. No jejunostomy was performed except in those patients at high risk of malnutrition, and a phantom jejunostomy was used instead. Both study groups are comparable in terms of epidemiological characteristics, etiology, preoperative tumor stage and neoadjuvant treatment. In group P, 86% of the patients underwent or already had a jejunostomy, 100% of the patients were left with a left thoracic drain and 28% with an abdominal drain. None of the patients had a cervical drain or NGT. In group T no cervical, abdominal or thoracic drain was placed, but 2 patients (8%) underwent a jejunostomy due to high risk of malnutrition. Table 1 shows the postoperative results. There are no significant differences in 90-day mortality, readmission rate or anastomotic leakage. Despite the widespread thought of the need for the use of chest drains after esophagectomy, abstention from their use, as well as abstention from the use of decompressive nasogastric tube and feeding jejunostomy (replacing it with the use of a ghost jejunostomy), does not increase morbimortality and improves the postoperative comfort of the patient, as well as the hospital stay.