P1.204. Comparison of Freka and MIC Feeding Jejunostomy Complications After Ivor Lewis Esophagectomy

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Feeding jejunostomy is frequently used as a nutritional adjunct following esophagectomy. Its routine placement remains debated, partially due to concerns regarding morbidity. Introduction of a robotic programme at the authors’ institution prompted evaluation of jejunostomy techniques. This study compared complications associated with Freka and MIC jejunostomies following Ivor Lewis esophagectomy. Methods All patients undergoing Ivor Lewis esophagectomy between October 2019 and May 2025 were included in this single-centre retrospective study. Patients without jejunostomy placement, with pre-existing jejunostomies, or with unavailable tube-type data were excluded. Feeding jejunostomy–related complications occurring during the index admission or within 90 days postoperatively were recorded. Complications were graded according to the Clavien–Dindo (CD) classification. Overall complication rates, severity distribution, and requirement for return to theatre were compared between Freka and MIC jejunostomy groups using chi-square testing. Results Of 341 esophagectomies performed during the study period, 312 patients were analysed (Freka n=157; MIC n=155). Jejunostomy-related complications occurred in 16 Freka (10.2%) and 13 MIC patients (8.4%) (p=0.58). Freka complications comprised 10 CD I–II (6.4%) and 6 CD III (3.8%) events, compared with 10 CD I–II (6.5%) and 3 CD III (1.9%) events in the MIC group (p=0.61). Return to theatre occurred in 1 Freka (0.6%) and 2 MIC patients (1.3%) (p=0.55), all due to small bowel obstruction. Infection was the most common complication (Freka n=8 vs MIC n=6), followed by tube dislodgement (Freka n=3 vs MIC n=3). Conclusion Feeding jejunostomy following Ivor Lewis esophagectomy is associated with a low overall complication rate. Freka and MIC jejunostomy tubes demonstrate comparable incidence and severity of complications, with no statistically significant difference in high-grade morbidity or return to theatre. The Freka system represents a feasible option in the robotic setting, however, further prospective evaluation is warranted.