Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy

Abstract

Background The optimal nutritional treatment after pancreatoduodenectomy is still unclear. The aim of this meta‐analysis was to investigate the impact of routine enteral nutrition following pancreatoduodenectomy on postoperative outcomes. Methods RCTs comparing enteral nutrition (regular oral intake with routine tube feeding) with non‐enteral nutrition (regular oral intake with or without parenteral nutrition) after pancreatoduodenectomy were sought systematically in the MEDLINE, Cochrane Library and Web of Science databases. Postoperative data were extracted. Random‐effects meta‐analyses were performed to compare postoperative outcomes in the two arms, and pooled odds ratios (ORs) or mean differences (MDs) were calculated with 95 per cent confidence intervals. In subgroup analyses, the routes of nutrition were assessed. Percutaneous tube feeding and nasojejunal tube feeding were each compared with parenteral nutrition. Results Eight RCTs with a total of 955 patients were included. Enteral nutrition was associated with a lower incidence of infectious complications (OR 0·66, 95 per cent c.i. 0·43 to 0·99; P = 0·046) and a shorter length of hospital stay (MD –2·89 (95 per cent c.i. –4·99 to –0·80) days; P < 0·001) than non‐enteral nutrition. Percutaneous tube feeding had a lower incidence of infectious complications (OR 0·47, 0·25 to 0·87; P = 0·017) and a shorter hospital stay (MD –1·56 (–2·13 to –0·98) days; P < 0·001) than parenteral nutrition (3 RCTs), whereas nasojejunal tube feeding was not associated with better postoperative outcomes (2 RCTs). Conclusion As a supplement to regular oral diet, routine enteral nutrition, especially via a percutaneous enteral tube, may improve postoperative outcomes after pancreatoduodenectomy.

Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study

“…The results in this study suggest that certain patient populations under the ERAS program for PD need perioperative EN; however, the efficacy of tube feeding after PD is controversial 37–39 . An on‐demand artificially administered nutrition strategy, which is initiated when patients can no longer ingest normal diets or develop serious complications, can only be implemented by nasoenteric tube feeding or parenteral nutrition.…”

“…The results in this study suggest that certain patient populations under the ERAS program for PD need perioperative EN; however, the efficacy of tube feeding after PD is controversial. [37][38][39] An on-demand artificially administered nutrition strategy, which is initiated when patients can no longer ingest normal diets or develop serious complications, can only be implemented by nasoenteric tube feeding or parenteral nutrition. Given that the patients without complications could consume >800 kcal from their diet 2 weeks postoperatively, as demonstrated in this study, it was not considered necessary to perform NCJ for all patients.…”

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

“…Pancreaticoduodenectomy (PD) is the only potentially curative procedure for the treatment of tumours located in the pancreatic head and periampullary region [ 1 , 2 ]. According to reports, the incidence rate of pancreatic cancer [ 3 ] and tumours of the periampullary area [ 4 ] are increasing year by year, which also means that cases of pancreaticoduodenectomy are increasing [ 5 ].…”

“…Postoperative pancreatic fistula (POPF) is one of the most severe and frequent complications following PD, the rate of which is up to 30% [6][7][8]. The leakage of pancreatic juice destroys the surrounding tissues and is a main causal factor of several ensuing complications, such as postoperative abdominal bleeding, abdominal abscess, organ dysfunction, and even death [1,2,[7][8][9][10].…”

This month on Twitter

“…Many people tweeted about the meta‐analysis by Tanaka et al . on routine enteral nutrition after pancreatoduodenectomy. Catherine Teh (@hpbsurgeon1) posted a poll about routine jejunostomy placement during pancreatoduodenectomy, and explained why she disagreed with the conclusions of the study.…”