Clinical value of helical nasointestinal tube placement in the enhanced recovery of patients with the radical gastrectomy for gastric cancer

Objective:To investigate the clinical value of helical nasointestinal tube placement in the enhanced recovery of patients with the radical gastrectomy for gastric cancer.
Methods:The clinical data of 74 patients who received radical gastrectomy at the Ruijin Hospital of Shanghai Jiaotong University from June 2012 to June 2014 were retrospectively analyzed. Thirtysix patients who received parenteral nutrition via helical nasointestinal tube were in the nasointestinal tube group, 15 patients who received nutritional support from the sinus tract after jejunostomy were in the jejunostomy group, 23 patients who received postoperative traditional parenteral nutrition duo to early treatment were in the parenteral nutrition group. The levels of albumin, prealbumin, number of lymph nodes, immunoglobin A (IgA), immunoglobin G (IgG) and immunoglobin M (IgM), the postoperative flatus time, incidence of postoperative complications (wound infection, peritoneal infection, intestinal obstruction, digestive tract leakage and delayed healing of incision) and duration of postoperative stay in the 3 groups were compared. Patients were followed up via outpatient examination and telephone interview till September 2014. The normal distribution measurement data were presented as ±s. The comparison among groups and pairwise comparison were evaluated with the analysis of variance and the LSDt test. The count data were analyzed using the chisquare test or Fisher exact probability.
Results:All the patients in the 3 groups were cured and discharged without perioperative death. No peritoneal infection, intestinal obstruction or delayed healing of incision occurred. The levels of albumin, number of lymph nodes, IgA, IgG and IgM at postoperative day 3 were (34±4)g/L, (0.9±0.3)×109/L, (1.9±0.8)g/L, (9.5±2.1)g/L, (1.00±0.29)g/L in the nasointestinal tube group, (34±4)g/L,(0.8±0.7)×109/L, (1.6±1.2)g/L, (8.2±1.4)g/L, (0.91±0.15)g/L in the jejunostomy group, and (31±5)g/L, (0.9±0.3)×109/L, (1.7±1.0)g/L, (9.3±1.8)g/L, (0.97±0.33)g/L in the parenteral nutrition group, with no significant difference among the 3 groups (F=2.168, 1.745, 2.115, 2.189, 2.124,P>0.05). The levels of albumin, number of lymph nodes, IgA, IgG and IgM at postoperative day 7 were (36±5)g/L,(1.7±0.5)×109/L, (2.3±1.2)g/L, (10.5±1.9)g/L, (1.40±0.40)g/L in the nasointestinal tube group, (35±5)g/L, (1.5±0.7)×109/L, (2.1±0.9)g/L, (10.4±2.1)g/L, (0.80±0.60)g/L in the jejunostomy group, and (32±5)g/L, (1.3±0.5)×109/L, (1.8±0.7)g/L, (8.2±2.1)g/L, (1.20±0.60)g/L in the parenteral nutrition group, with no significant difference among the 3 groups (F=2.225, 1.785, 2.756, 2.882, 2.278, P>0.05). The incidence of postoperative wound infection, digestive tract leakage and duration of postoperative stay were 1, 0, (7.2±1.8)days in the nasointestinal tube group, 0, 0, (8.1±2.2)days in the jejunostomy group, and 0, 1, (7.8±2.6)days in the parenteral nutrition group, with no significant difference among the 3 groups (F=1.688, P>0.05). The levels of prealbumin at postoperative day 3 and 7 and the postoperative flatus time were (168±34)mg/L, (167±32)mg/L, (3.1±1.6)days in the nasointestinal tube group, (162±36)mg/L, (166±34)mg/L, (3.3±2.1)days in the jejunostomy group, and (127±38)mg/L, (118±26)mg/L, (4.2±2.1)days in the parenteral nutrition group, with a significant difference among the 3 groups (F=4.109, 4.438, 3.425, P<0.05). The levels of prealbumin at postoperative day 3 and 7 in the nasointestinal tube group and the jejunostomy group were significantly higher than those in the parenteral nutrition group, and the postoperative flatus time of the nasointestinal tube group and the jejunostomy group were significantly shorter than that of the parenteral nutrition group, with a significant difference (t=2.178, 2.225, 2.189, 2.185, 2.228, 2.155, P<0.05). There were no significant differences in the levels of preambumin at postoperative day 3 and 7 and the postoperative flatus time between the nasointestinal tube group and the jejunostomy group (t=1.755, 1.408, 1.733, P>0.05). All the patients were followed up for 2-24 months, with the median time of 12 months. No patient was readmitted to the hospital due to postoperative complications.
Conclusions:Early enternal nutrition support via the helical nasointestinal tube after radical gastrectomy for gastric cancer is more effective than parenteral nutrition support, and with the advantages of easy manipulation, little trauma and obvious efficacy. The nutritional condition and the intestinal function of the patients could be improved and thus the recovery is speeded up.