Esophagectomy is one of the most challenging surgeries in the field of foregut disease due to its complexity and high rate of postoperative complications. A recent report by Vignesh N et al. [1] provides a detailed examination of nasogastric tube (NGT) exclusion following minimally invasive esophagectomy. The findings showed that omitting the NGT did not affect the rate of anastomosis leakage. Moreover, the institutional Enhanced Recovery After Surgery (ERAS) program yielded excellent postoperative outcomes following minimally invasive esophagectomy. Routine use of NGT during regular intraabdominal surgeries is not recommended due to various side effects such as throat pain, nasal mucosal damage, delayed bowel recovery, delayed time to oral diet, and pulmonary complications [2,3]. In contrast, the ERAS guidelines for esophagectomy recommend the placement and early removal of the NGT within 2 days [4]. Some esophageal surgeons might be hesitant to exclude NGT or remove the NTG early due to concerns about anastomosis complications. In this study, no additional anastomotic risk were observed when omitting the NGT.

However, this study has some limitations in demonstrating the significance of omitting the NGT. First, the retrospective nature of this study is a limitation, especially since the control group (NGT inserted and removed by the third postoperative day) and the experimental group (without NGT insertion) underwent surgeries at different times. The control group had their surgeries in the past, but the experimental group had their surgeries more recently. Since the learning curve can affect the outcome of esophagectomy, more recent surgeries may have better outcomes. Additionally, anastomosis method changed from hand sewing to stapling during the study period. Since anastomotic complications are a primary outcome, this change in technique could influence the results.

Nonetheless, this study is significant as it collected data prospectively and shows postoperative results adhering to the ERAS protocol. These findings are particularly relevant in minimally invasive esophagectomy, which has become the standard due to its superior perioperative outcomes. The comparable rates of anastomotic leaks and major complications between the two groups underscore the safety of NGT exclusion. Additionally, this study highlights the essential aspect of the ERAS protocols—enhancing patient comfort and promoting early mobilization and oral intake, which are crucial for recovery.

Conflict of interest

The authors have no conflicts of interest to declare.

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