In a groundbreaking large-scale study encompassing the Nordic countries, researchers have revisited a long-standing surgical practice linked to oesophageal cancer treatment, unveiling findings that challenge recent shifts in postoperative care. This pivotal research, spearheaded by experts at Uppsala University, offers compelling evidence that the continued use of decompression via a nasogastric tube after oesophagectomy correlates with significantly fewer severe complications. These results, published in the prestigious journal The Lancet Regional Health – Europe, have profound implications for surgical protocols and patient recovery worldwide.
Oesophagectomy, the surgical removal of cancerous sections of the oesophagus, remains one of the most complex and high-risk procedures in oncology. A traditional yet sometimes contentious aspect of postoperative management involves leaving a nasogastric tube—a slender, flexible plastic tube inserted through the nose into the stomach—as a means to decompress the digestive tract. This tube facilitates the reduction of intraluminal pressure in the operated area, theoretically mitigating the risk of anastomotic leakage, a dangerous complication characterized by fluid escaping from the surgical connection between the remaining ends of the oesophagus and stomach.
Historically, the balance between the benefits and drawbacks of nasogastric decompression has been debated. Numerous smaller studies had suggested that omitting the tube might be safe and more comfortable for patients, resulting in a gradual decline in its use following major gastrointestinal surgeries. However, these studies often struggled with limited sample sizes, lacking the statistical power necessary to deliver definitive recommendations. Recognizing this knowledge gap, a multinational Nordic collaboration embarked on a rigorous, randomized controlled trial to establish clarity.
The trial mobilized twelve leading university hospitals across Sweden, Norway, Denmark, and Finland, enrolling nearly 450 patients who underwent oesophagectomy for cancer. Participants were randomly assigned either to receive routine nasogastric decompression or to omit the tube postoperatively. This design provided a robust framework to evaluate outcomes, chiefly focusing on the incidence of anastomotic leakage, postoperative complications, and overall patient prognosis.
Contrary to prevailing assumptions, the study revealed that patients without the nasogastric tube exhibited a higher frequency of leakage at the anastomotic site. This finding is clinically significant, as anastomotic leakage is often associated with severe morbidity, necessitating urgent interventions such as surgical repair or endoscopic procedures frequently conducted under general anesthesia. These events exacerbate patient discomfort, prolong hospital stays, and increase healthcare burdens, underscoring the importance of preventive measures.
Interestingly, while the leakage rate differed, no statistically significant disparities emerged concerning long-term survival or the occurrence of other postoperative complications between the two groups. This nuance suggests that the nasogastric tube’s protective effect is highly specific to leakage prevention without broadly influencing other clinical outcomes. The precise physiological mechanisms behind this benefit remain under investigation, but current hypotheses posit that decompression reduces pressure on the suture line, fostering optimal healing conditions.
The sheer scale and methodological rigor of this study represent a remarkable achievement in the field of surgical oncology. Oesophageal cancer surgeries number approximately 200 annually in Sweden alone, rendering multinational collaborations essential to amassing sufficient data for high-quality evidence. Within a relatively brief window of just over two years, the Nordic network successfully enrolled nearly 450 patients, marking one of the largest trials in this domain to date. The collaborative nature of this venture exemplifies the power of regional healthcare alliances in advancing clinical knowledge.
Dr. Jakob Hedberg, the study’s principal investigator and an associate professor at Uppsala University, emphasizes the dual impact of these findings—both on immediate patient care and on the future landscape of surgical research. The affirmation of nasogastric tube benefits prompts a reevaluation of current trends deprioritizing its use after oesophagectomy. Such evidence-based reassessments ensure that care protocols prioritize patient safety and quality of life rather than convenience or tradition.
Moreover, the success of this trial has fortified the existing Nordic clinical research network, setting a strong precedent for future investigations. The infrastructure and collaborative spirit cultivated through this study pave the way for upcoming trials designed to tackle other pressing questions in surgical oncology. This momentum highlights an exciting era where multidisciplinary and cross-border partnerships can accelerate transformative improvements in cancer treatment.
International interest in these preliminary findings has been substantial. Presentations at global medical conferences have generated considerable discussion among surgical oncologists, gastroenterologists, and perioperative care specialists. The implications extend beyond the Nordic region, potentially influencing guidelines worldwide, as solid evidence of this caliber demands careful attention from clinical societies and healthcare policymakers.
The nasogastric tube, often viewed as an uncomfortable and cumbersome device, emerges from this research as a critical tool that safeguards patient outcomes in oesophageal cancer surgery. Its role in preventing anastomotic leakage not only reduces the individual’s suffering but also alleviates system-wide strains associated with managing complex postoperative complications. As patient-centered care evolves, balancing technological and methodological advances with tried-and-true practices will remain essential.
Future studies will likely delve deeper into optimizing nasogastric tube management—exploring aspects such as ideal duration, timing of removal, and patient-specific factors influencing its efficacy. This nuanced understanding will refine postoperative protocols further, tailoring interventions to individual risk profiles and enhancing recovery trajectories. Ultimately, integrating such insights promises to elevate standards of care, making life-saving oesophageal surgeries safer and more tolerable.
In conclusion, the Nordic multicenter randomized controlled trial decisively reinstates the value of nasogastric decompression following oesophagectomy. Its statistical robustness and clinical relevance offer a compelling counter-narrative to the recent decline in tube usage, urging a re-examination of common surgical practices. The trial’s success underscores the critical importance of collaborative research, demonstrating how evidence-based medicine can directly improve outcomes for patients battling esophageal cancer.
Subject of Research: People
Article Title: Nasogastric tube after oesophagectomy and risk of anastomotic leak: a Nordic, multicentre, open-label, randomised, controlled, non-inferiority trial
News Publication Date: 31-Jul-2025
Web References: 10.1016/j.lanepe.2025.101411
Image Credits: Jakob Hedberg
Keywords: oesophageal cancer, oesophagectomy, nasogastric tube, anastomotic leakage, randomized controlled trial, postoperative complications, surgical oncology, Nordic study, decompression, patient safety
