Researchers have found clear evidence that decompression with a nasogastric tube is linked to fewer serious complications in oesophageal cancer surgery.
In the most comprehensive Nordic study to date, the findings challenge the trend of decreasing use of nasogastric tubes after major surgical procedures.
The study, led by Uppsala University, is published in Lancet Regional Health Europe.
Several small studies had previously suggested that it is safe to abandon the tradition of leaving in a decompressing (often unpleasant) nasogastric tube after surgery to remove oesophageal cancer.
The tube is intended to alleviate and lower pressure in the recently operated area.
Nordic research collaboration concluded that these smaller studies lacked sufficient statistical power to justify a change in care.
Subsequently, a randomised trial was carried out at 12 university hospitals across Sweden, Norway, Denmark and Finland, where patients were randomly assigned to either have or not have a decompressing nasogastric tube inserted into their oesophagus following this type of surgery.
To the researchers’ surprise, omitting the tube after this surgery was not without risk, as more patients without the tube experienced leakage at the anastomosis performed during the operation.
Leakage must be addressed immediately, often requiring interventions under general anaesthesia, which can cause suffering for the patient and extend the length of hospital stay.
Although no differences in survival rates or other complications were observed, this new knowledge could help to reduce suffering for patients in the future.
Jakob Hedberg, surgical oncologist, associate professor at Uppsala University and consultant surgeon at Uppsala University Hospital, who is also principal investigator for the study, said: ‘Oesophageal cancer is an uncommon form of cancer, with only about 200 operations of this type being performed per year in Sweden. National and international cooperation is, therefore, absolutely necessary in order to conduct sufficiently large trials to answer the research questions we have. The fact that in just over two years, almost 450 patients have been recruited for the trial surpassed our expectations and represents a great success for this network.
‘Strong interest has been shown at international conferences where our preliminary results have been presented, and the principle of building surgical care on solid evidence has allowed us to provide the best care to our patients. Another important effect of this successful collaboration is that we can build more clinical trials within the Nordic network, which has now been consolidated. In fact, the next clinical trial is already under development.’
