Nasogastric- vs. percutaneous gastrostomy tube for prophylactic gastric decompression after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Job P Van Kooten,Nadine L De Boer,Marjolein Diepeveen,Alexandra R M Brandt-Kerkhof,Eva V E Madsen,Cornelis Verhoef,Jacobus W A Burger

doi:10.1515/pp-2021-0107

Abstract

ObjectivesCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with postoperative gastroparesis and ileus. In 2015, our practice shifted from using percutaneous gastrostomy tubes (PGT), to nasogastric tubes (NGT) for prophylactic gastric decompression after CRS-HIPEC. This study aimed to compare these methods for length of stay (LOS) and associated complications.MethodsPatients that underwent CRS-HIPEC for peritoneal metastases from colorectal cancer between 2014 and 2019 were included. Cases were grouped based on receiving NGT or PGT postoperatively. Multivariable linear regression determined the independent effect of decompression method on LOS, thereby adjusting for confounders.ResultsIn total, 179 patients were included in the analyses. Median age was 64 years [IQR:54–71]. Altogether, 135 (75.4%) received a NGT and 44 (24.6%) received a PGT. Gastroparesis occurred significantly more often in the PGT group (18.2 vs. 7.4%, p=0.039). Median LOS was significantly shorter for patients with a NGT (15 [IQR:12–19] vs. 18.5 [IQR:17–25.5], p<0.001). PGT was independently associated with longer LOS in multivariable analysis (Beta=4.224 [95%CI 1.243–7.204]). There was no difference regarding aspiration, pneumonia and postoperative mortality between groups.ConclusionsNGT should be preferred over PGT for gastric decompression after CRS-HIPEC as it is associated with fewer gastroparesis and shorter LOS.

Highlights

Colorectal carcinoma (CRC) is one of the most prevalent forms of cancer
A recent survey by Maciver et al among 97 high-volume Cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemotherapy (HIPEC) surgeons revealed that 74% does not apply early recovery after surgery (ERAS) protocols, 83% routinely places nasogastric tubes (NGT) and 59% routinely uses nutritional supplementation of which 18% consists of enteral feeding through NGTs or percutaneous gastrostomy tubes (PGT) [10]
This study shows that PGT for prophylactic gastric decompression and enteral feeding after CRS-HIPEC results in prolonged length of stay (LOS) when compared to NGT

Summary

Introduction

Colorectal carcinoma (CRC) is one of the most prevalent forms of cancer. Approximately 8% of patients will at some point develop peritoneal metastases (PM) [1–3]. A potentially curative treatment for PM is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) [4, 5]. This procedure is associated with considerable postoperative morbidity [6]. There is no consensus on the routine use of gastric decompression, nutritional supplementation, or ‘early recovery after surgery’ (ERAS) practices after CRS-HIPEC. A recent survey by Maciver et al among 97 high-volume CRS-HIPEC surgeons revealed that 74% does not apply ERAS protocols, 83% routinely places nasogastric tubes (NGT) and 59% routinely uses nutritional supplementation of which 18% consists of enteral feeding through NGTs or percutaneous gastrostomy tubes (PGT) [10]. Possible advantages of a PGT over NGT are less dislocation of the tube, less respiratory tract infections and especially less patient discomfort [11]. NGT on the other hand is considered less invasive, causes

Objectives

Methods

Discussion

Conclusion