A Multicenter prospective randomized trial

Giovani Battista Doglietto, M.D.; Valerio Papa, M.D.; Antonio Pio Tortorelli, M.D.;  Maurizio Bossola, M.D.; Marcello Covino, M.D.; Fabio Pacelli, M.D. for the Italian Total Gastrectomy Study Group.

Arch Surg. 2004 Dec; 139(12):1309-13

HYPOTHESIS: Anastomotic disruption of the Roux-en-Y esophagojejunostomy after total gastrectomy is an infrequent complication that may lead to severe morbidity and mortality. Consequently, a nasojejunal tube (NJT) is frequently placed when this operation is performed. However, no studies have compared routine vs no placement of an NJT in patients undergoing total gastrectomy for gastric cancer, to our knowledge. DESIGN: Randomized controlled trial to assess the need for routine nasojejunal decompression after total gastrectomy with Roux-en-Y esophagojejunostomy in patients with gastric cancer. SETTING: Tertiary care centers. PATIENTS: Two hundred thirty-seven patients undergoing total gastrectomy for gastric cancer were randomly assigned to NJT placement (NJT group) or not (no-NJT group). The patients were monitored for postoperative complications, mortality, and postoperative course. MAIN OUTCOME MEASURES: Incidence of esophagojejunostomy leak. RESULTS: The rates of anastomotic leak were similar in both groups (6.9% and 5.8% for the NJT group and no-NJT group, respectively; P = .71), as were the rates of major postoperative complications (25.9% and 21.5%, respectively; P = .42) and overall postoperative mortality (0.9% and 0.8%, respectively; P = .50). There were no differences between the 2 groups in the mean+/-SD time to passage of flatus (4.6 +/- 1.3 and 4.5 +/- 1.7 days, respectively) or to starting a liquid diet (7.8 +/- 2.6 and 7.7 +/- 1.6 days, respectively), postoperative length of hospital stay (13.5 +/- 7.3 and 13.9 +/- 10.9 days, respectively), postoperative pain, or postoperative abdominal distention. CONCLUSION: Routine placement of an NJT after Roux-en-Y esophagojejunostomy is unnecessary in elective total gastrectomy for gastric cancer.