Non-placement of nasogastric tube versus early removal of nasogastric tube in the enhanced recovery after surgery of hepatocellular carcinoma: a case control study

BACKGROUND: Non-placement of nasogastric tube (NPGT) before operation for elective abdominal surgery and early removal of nasogastric tube (ERGT) are encouraged in clinical practice. However, it is not clear whether these two measures are applicable to all patients with HCC undergoing hepatectomy. METHODS: Demographic characteristics, surgical variables, comfort, and postoperative outcome of 412 patients were retrospectively analyzed. RESULTS: The NPGT group comprised 225 patients, while the ERGT group comprised 187 patients. There was no significant difference between the two groups in sex, age, operation time, body mass index, hepatic function, type of hepatectomy, first anal exhaust time, half-liquid eating time, length of postoperative hospital stays, and incidence of postoperative complications before and after propensity score matching (PSM). Compared with the ERGT group, the postoperative incidence of nasopharyngeal discomfort (23.0% vs. 3.11%), nausea and vomiting (14.44% vs. 8.0%), and sore throat (20.86% vs. 2.22%) was significantly lower in the NPGT group (all P < 0.05), even after PSM. A long operation time, and a history of abdominal surgery were independent risk factors for postoperative nasogastric tube placement in the NPGT group. Receiver operating characteristic curve showed an operation time of > 326 min with a maximum area under the curve of 0.744. CONCLUSIONS: Patients with HCC undergoing hepatectomy without prophylactic nasogastric tube placement have a low but measurable risk of postoperative nasogastric tube re-insertion. Preoperative nasogastric tube insertion is recommended for patients with a history of abdominal surgery and/or estimated operation time of > 326 min.