A Systematic Review and Meta Analysis of the Necessity for Routine Jejunostomy Post Esophagectomy

Background The routine use of a feeding jejunostomy tube (FJT) after esophagectomy is increasingly debated, as evidence suggests it may be outdated due to concerns over postoperative and tube-related complications, including bowel dysfunction, infections, and long-term morbidity. This debate is even more pronounced in the era of minimally invasive esophagectomy (MIE), including robotic-assisted MIE, where enhanced recovery protocols favor early oral feeding and alternative nutritional strategies. This systematic review and meta-analysis consolidates existing research to assess the risks and benefits of FJT, guiding clinical decisions on patient selection and postoperative nutrition management. Methods A systematic search was conducted in EMBASE, PubMed, and the Cochrane Library from inception until August 24 2024, identifying 24 studies, including 12 newly published studies. A random-effects meta-analysis was performed to compare paired outcomes between patients with and without FJT. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the Mantel–Haenszel method, with heterogeneity assessed via I2 statistics. Publication bias was evaluated using funnel plots. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results No significant difference was observed between FJT and non-FJT groups in 30-day mortality, readmission rates, sepsis, thromboembolic events, chyle leak, and recurrent laryngeal nerve palsy. However, several outcomes indicated potential drawbacks of FJT placement: Further subgroup analyses are planned to explore additional factors influencing these outcomes. Conclusion