Surg Today (2018) 48:127
LETTER TO THE EDITOR
One‑day nasogastric tube decompression after distal gastrectomy:
a prospective randomized study
· Laura Marciano
Received: 15 May 2017 / Accepted: 5 June 2017 / Published online: 19 July 2017
© Springer Japan KK 2017
conducted, it is essential to preliminarily establish the num-
ber of individuals needed to reach suﬃcient statistical power.
In particular, the sample size calculation is inﬂuenced by
the frequency of occurrence of the phenomenon we want to
test; that is, the lower the occurrence, the larger the sample
size needed to achieve suﬃcient statistical power. Moreover,
the sequence allocation method was not speciﬁed and this is
another relevant element that must be mentioned when per-
forming a randomized trial . When a new approach or
surgical technique (or variation of a pre-existing protocol) is
introduced, it is important that it is accurately standardized
to achieve reproducible results among diﬀerent centers .
Hence, it would be interesting to conduct additional prospec-
tive multicenter trials in the same area to conﬁrm the authors’
interesting conclusions and add further robust and statisti-
cally based data.
Again, we thank our colleagues for their strong contribu-
tion toward a better understanding of this topic.
Compliance with ethical standards
Conﬂict of interest The authors declare that they have no competing
1. Kimura Y, Yano H, Iwazawa T, Fujita J, Fujita S, Yamamoto K,
Yasuda T. One-day nasogastric tube decompression after distal
gastrectomy: a prospective randomized study. Surg Today. 2017.
2. Dettori J. The random allocation process: two things you need to
know. Evid Based Spine Care J. 2010;1(03):7–9.
3. Mangano A, Rausei S, Lianos GD, Dionigi G. Quality of life
after gastrectomy for adenocarcinoma: a prospective cohort
study. Ann Surg. 2015;262(6):e110.
Keywords Distal gastrectomy · Nasogastric tube ·
Evidence based surgery · Randomized controlled trial
We do appreciate the aim of the prospective, randomized trial
conducted by Kimura et al. , to assess whether standard
1-day nasogastric tube (NGT) decompression is an avoidable
step in distal gastrectomy. De facto, distal gastrectomy is a
common operation, particularly in Asia, with a not uncom-
mon complication rate. Hence, we read this valuable manu-
script with extreme interest. We agree with the authors that
at this stage, the scientiﬁc literature has not clariﬁed whether
the uncomfortable procedure of 1-day NGT placement is of
clinical beneﬁt in preventing postoperative complications.
For this reason, if the aforementioned question is answered,
we could theoretically avoid inﬂicting the discomfort of NGT
decompression on patients undergoing distal gastrectomy. In
their conclusion, our colleagues claim that there were no sig-
niﬁcant postoperative complications or postoperative course
recovery diﬀerences between the NGT and non-NGT arms
of their series. However, despite using appropriate statisti-
cal tests, it does not seem that they have calculated a pre-hoc
sample size. In other words, whenever a prospective study is
This comment refers to the article available at
* Alberto Mangano
Via Mulini 12, 22015 Gravedona ed Uniti (Como), Italy
University Center of Statistics for the Biomedical Sciences,
Vita-Salute San Raﬀaele University, Via Olgettina 58,
20132 Milan, Italy