Postoperative outcomes after esophagectomy with versus without routine nasogastric tube placement: a retrospective cohort study

Routine nasogastric tube (NGT) placement after esophagectomy has traditionally been used for gastric conduit decompression. Enhanced recovery pathways have questioned routine decompression, but evidence remains limited, particularly in low- and middle-income settings. This single-centre retrospective cohort study included adults undergoing elective esophagectomy for non-metastatic esophageal or gastroesophageal junction carcinoma between April 2023 and April 2025. Patients were grouped according to intraoperative NGT placement. Outcomes included postoperative complications, anastomotic leak, aspiration pneumonia, vomiting, high dependency unit (HDU) stay, total hospital stay and 30-day mortality. Multivariable regression explored associations between NGT placement and postoperative outcomes after adjustment for tumour location, operative time, estimated blood loss and ASA score. Seventy-seven patients were included; 33 underwent NGT placement and 44 did not. NGT use decreased over time as institutional practice evolved. Gastroesophageal junction tumours were more frequent in the NGT group, and operative time and estimated blood loss were higher. The overall anastomotic leak rate was 2.6% (2/77), with one leak in each group. No aspiration pneumonia occurred. HDU stay and total hospital stay were longer in the NGT group. After adjustment, NGT placement remained associated with longer HDU stay (adjusted beta 0.84 days, 95% CI 0.37 to 1.31, p = 0.001) and longer total hospital stay (adjusted beta 0.98 days, 95% CI 0.24 to 1.71, p = 0.010). Exploratory logistic regression for complications produced an imprecise estimate (adjusted OR 8.08, 95% CI 1.10 to 59.54). In this selected cohort, omission of routine NGT placement showed no obvious adverse safety signal, but the study was small, retrospective and confounded by surgeon selection and temporal practice change. The findings are hypothesis-generating and support further prospective evaluation of selective NGT management within structured perioperative pathways.