Impact of Gastric Tubulization in McKeown Esophagectomy on Patient-Reported Outcomes

Background The optimal shape of gastric tubes for post-discharge alimentary comfort in patients undergoing esophagectomy for cancer remains underexplored. This study aimed to identify the factors associated with gastric tubulization that influence patient-reported outcomes (PROs) related to alimentary quality of life (QOL). Methods This single-center, retrospective study included 257 patients with esophageal cancer who underwent McKeown esophagectomy with gastric tube reconstruction between January 2019 and May 2021. Gastric tubulization factors were evaluated using postoperative CT scans. PROs were assessed using alimentary-related domains from the European Organization for Research and Treatment of Cancer QOL Questionnaire Core 30 and the QLQ-Oesophagus module, from pre-surgery to six months post-surgery. Mixed-effects models were employed to longitudinally analyze the impact of gastric tube position, width and antrum width on PRO domains. Results Compared with chest gastric tubes in the right chest cavity (n = 62), mediastinal gastric tubes on the midline (n = 195) exhibited a narrower gastric tube width (5.01 cm vs. 2.92 cm; p < 0.01) and a wider gastric antrum (2.70 cm vs. 3.71 cm; p < 0.01). The antrum width significantly increased over time (p < 0.01). A wider gastric antrum correlated with lower scores in Fatigue (p = 0.02), Dysphagia (p < 0.01), and Eating (p = 0.02), and was linked to higher global health status/QOL scores (p = 0.01). Mediastinal gastric tubes were associated with lower Pain scores (p = 0.01). A wider gastric tube was correlated with lower scores in Eating (p = 0.03) and Choked when swallowing (p < 0.01). Conclusion Gastric tubulization significantly impacts alimentary comfort following McKeown esophagectomy based on PROs. The optimal gastric antrum width is a critical factor in reducing postoperative symptom burden and improving QOL.