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Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy Janssen, Henricus J. B. Gantxegi Madina, Amaia Fransen, Laura F. C. Nieuwenhuijzen, Grard A. P. Luyer, Misha D. P. Institut Català de la Salut [Janssen HJB, Fransen LFC, Nieuwenhuijzen GAP, Luyer MDP] Department of Surgery, Catharina Hospital, 5602ZA Eindhoven, The Netherlands. [Gantxegi A] Servei de Cirurgia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain Vall d'Hebron Barcelona Hospital Campus Esòfag - Cirurgia - Complicacions Cirurgia endoscòpica Alimentació ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Digestive System Surgical Procedures::Esophagectomy Other subheadings::Other subheadings::Other subheadings::/adverse effects ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Minimally Invasive Surgical Procedures PHENOMENA AND PROCESSES::Physiological Phenomena::Diet, Food, and Nutrition::Nutritional Physiological Phenomena::Eating TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo::esofagectomía Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos mínimamente invasivos FENÓMENOS Y PROCESOS::fenómenos fisiológicos::dieta, alimentación y nutrición::fenómenos fisiológicos nutricionales::ingestión de alimentos Càncer d'esòfag; Jejunostomia; Nutrició Cáncer de esófago; Yeyunostomía; Nutrición Esophageal cancer; Jejunostomy; Nutrition Recently, it has been shown that directly starting oral feeding (DOF) from postoperative day one (POD1) after a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) can further improve postoperative outcomes. However, in some patients, tube feeding by a preemptively placed jejunostomy is necessary. This single-center cohort study investigated risk factors associated with failure of DOF in patients that underwent a MIE-IL between October 2015 and April 2021. A total of 165 patients underwent a MIE-IL, in which DOF was implemented in the enhanced recovery after surgery program. Of these, 70.3% (n = 116) successfully followed the nutritional protocol. In patients in which tube feeding was needed (29.7%; n = 49), female sex (compared to male) (OR 3.5 (95% CI 1.5–8.1)) and higher ASA scores (III + IV versus II) (OR 2.2 (95% CI 1.0–4.8)) were independently associated with failure of DOF for any cause. In case of failure, this was either due to a postoperative complication (n = 31, 18.8%) or insufficient caloric intake on POD5 (n = 18, 10.9%). In the subgroup of patients with complications, higher ASA scores (OR 2.8 (95% CI 1.2–6.8)) and histological subtypes (squamous-cell carcinoma versus adenocarcinoma and undifferentiated) (OR 5.2 (95% CI 1.8–15.1)) were identified as independent risk factors. In the subgroup of patients with insufficient caloric intake, female sex was identified as a risk factor (OR 5.8 (95% CI 2.0–16.8)). Jejunostomy-related complications occurred in 17 patients (10.3%). In patients with preoperative risk factors, preemptively placing a jejunostomy may be considered to ensure that nutritional goals are met. The previous NUTRIENT II trial was funded by KWF Kankerbestrijding (Dutch Cancer Society, grant number 10495) and Medtronic (20130529). 2022-05-06T12:55:27Z 2022-05-06T12:55:27Z 2021-10 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Janssen HJB, Gantxegi A, Fransen LFC, Nieuwenhuijzen GAP, Luyer MDP. Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy. Nutrients. 2021 Oct;13(10):3616. 2072-6643 https://hdl.handle.net/11351/7493 10.3390/nu13103616 34684617 000715144200001 http://hdl.handle.net/11351/7493 eng Nutrients;13(10) https://doi.org/10.3390/nu13103616 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf application/pdf MDPI Scientia