Objectives  To improve the surgical procedures and investigate the feasibility of the closed placement of nasojejunal tube during Ivor-Lewis esophagectomy.

  Methods  From January 2010 to December 2013, 85 patients (72 males and 13 females) with esophageal or gastric cardiac carcinoma underwent Ivor-Lewis esophagectomy in our department.Briefly, the general surgical procedures were performed as follows:1) stomach mobilization and enlargement of esophageal hiatus and pyloric sphincter digital fracture via laparotomy; 2) tubular stomach reconstruction, esophageal carcinoma resection, and intra-thoracic esophagogatrostomy via right posterolateral thoracotomy; and 3) forward closed placement of feeding tube through the nostrils and jejunum of patients under the guidance of a surgeon, who palpates the pylorus through the hiatus with the use of fingers.

  Results  No operative death or feeding tube-associated adverse event was observed.Among the 85 patients who have undergone Ivor-Lewis esophagectomy, feeding tube placement into the jejunum during surgery failed in 33 cases.The success rate of nasojejunal feeding tube placement was 61.2%(52/85).Twelve patients with successful tube placement did not receive enteral feeding for several reasons and were thereby transferred to parenteral group.Significant differences were observed in terms of the nutritional cost and proportion between enteral feeding and parenteral groups (?1, 469 ± 741 vs. ? 3, 223 ± 917, P < 0.001;3.4% vs. 7.2%, P < 0.001).No differences in postoperative hospital stay and morbidity were observed between the two groups (P>0.05).

  Conclusion  The novel forward closed placement of nasojejunal feeding tube during Ivor-Lewis esophagectomy provides a non-invasive, feasible, simple, and economical method for postoperative nutritional support.Surgeons could perform this novel technique successfully in practice.