Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy

Périnel, Julie; Mariette, C.; Dousset, B.; Sielezneff, I.; Gainant, A; Mabrut, Jean‐Yves; Bin-Dorel, Sylvie; Bechwaty, M. El; Delaunay, Dominique; Bernard, Laure; Sauvanet, Alain; Pocard, Marc; Buc, Emmanuel; Adham, Mustapha

doi:10.1097/sla.0000000000001896

Cited by 105 publications

(75 citation statements)

References 43 publications

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“…In this issue of Annals of Surgery, Perinel et al demonstrated contrasting results to those of previous studies that reported the benefits of EEN in patients undergoing PD (10). This was a prospective, multicenter, and randomized controlled trial involving 204 patients (age, >18 years) undergoing PD at nine French institutions.…”

contrasting

confidence: 40%

Early enteral nutrition still has advantages in patients undergoing pancreaticoduodenectomy

Lee¹,

Lee²

2016

J. Thorac. Dis.

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contrasting

confidence: 40%

Early enteral nutrition still has advantages in patients undergoing pancreaticoduodenectomy

Lee¹,

Lee²

2016

J. Thorac. Dis.

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“…A total of 51 articles were utilized for the review, with 14 addressing malnutrition and pancreatic dysfunction at pancreatic cancer diagnosis [13,14,15,16,17,18,19,20,21,22,23,24,25,26]; 19 addressing pancreatic dysfunction after surgery [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], including 10 which also discussed preoperative dysfunction and nutrition [27,30,31,32,33,35,37,39,40,41]; and 18 addressing nutritional intervention [11,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] (Figure 1). …”

Section: Resultsmentioning

confidence: 99%

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

et al. 2017

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Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995–2016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin < 2.5 mg/dL or weight loss > 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin < 3 mg/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient’s quality of life.

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“…Postoperative therapy with other somatostatin analogs has not been shown to be effective [38]. Postoperative total parenteral nutrition also reduces the fistula rate compared to early postoperative nasojejunal enteral nutrition [31]. The value of the omission of intraoperative drain placement is currently unclear: It reduced the pancreatic fistula rate in one multicenter trial [39] but led to an increase in morbidity and mortality in another study [40].…”

Section: Prevention Of Postoperative Pancreatic Fistulamentioning

confidence: 99%

“…The nationwide perioperative mortality rate was even higher (7.7%) and did not improve between 2009 and 2013 [30]. The high perioperative mortality is associated with a morbidity of up to 50%, mostly due to procedure-related complications [31]. While anastomotic leakage of the biliary and gastrointestinal anastomosis is exceedingly rare, leakage of the pancreatic anastomosis, i.e.…”

Section: Introductionmentioning

confidence: 99%

Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

Hummel

Bausch

2017

Visc Med

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Background: Anastomotic leakage after upper gastrointestinal surgery is associated with major morbidity and mortality. In recent years, there was a major paradigm shift in the management of leakage after upper gastrointestinal surgery from surgical towards conservative and endoscopic treatment approaches as first-line treatment options. Methods: We conducted a PubMed literature search using combinations of the keywords ‘leakage', ‘complication', ‘esophagectomy', ‘gastrectomy', and ‘pancreatectomy' to identify relevant publications. Results: Surgical re-intervention after esophagectomy, gastrectomy, or pancreatectomy is still indicated in selected patients, depending on the severity of symptoms, the condition of the patient, and failure of initiated treatment. Furthermore, surgical revision after esophagectomy and gastrectomy is indicated for early leakage and depends on the extent of anastomotic disruption and the condition of tissue. Conclusion: Surgical re-intervention still plays a crucial role in the management of leakage after upper gastrointestinal surgery, especially in critically ill patients and after failure of conservative or endoscopic treatment.

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Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy

Abstract: In patients undergoing PD, NJEEN was associated with an increased overall postoperative complications rate. The frequency and the severity of POPF were also significantly increased after NJEEN. In terms of safety and feasibility, NJEEN should not be recommended.

Cited by 105 publications

References 43 publications

Early enteral nutrition still has advantages in patients undergoing pancreaticoduodenectomy

Early enteral nutrition still has advantages in patients undergoing pancreaticoduodenectomy

Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

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