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. 2024 Feb 29;28(1):70-79.
doi: 10.14701/ahbps.23-071. Epub 2023 Dec 14.

Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study

Thomas B Russell  1 , Peter L Labib  1 , Paula Murphy  1 , Fabio Ausania  2 , Elizabeth Pando  3 , Keith J Roberts  4 , Ambareen Kausar  5 , Vasileios K Mavroeidis  6   7 , Gabriele Marangoni  8 , Sarah C Thomasset  9 , Adam E Frampton  10 , Pavlos Lykoudis  11 , Manuel Maglione  12 , Nassir Alhaboob  13 , Hassaan Bari  14 , Andrew M Smith  15 , Duncan Spalding  16 , Parthi Srinivasan  17 , Brian R Davidson  18 , Ricky H Bhogal  7 , Daniel Croagh  19 , Ismael Dominguez  20 , Rohan Thakkar  21 , Dhanny Gomez  22 , Michael A Silva  23 , Pierfrancesco Lapolla  24 , Andrea Mingoli  24 , Alberto Porcu  25 , Nehal S Shah  26 , Zaed Z R Hamady  27 , Bilal Al-Sarrieh  28 , Alejandro Serrablo  29 ; RAW Study Collaborators; Somaiah Aroori  1
Collaborators, Affiliations

Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study

Thomas B Russell et al. Ann Hepatobiliary Pancreat Surg. .

Abstract

Backgrounds/aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes.

Methods: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes.

Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN.

Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.

Keywords: Nutritional status; Nutritional support; Nutritionists; Pancreatic ductal carcinoma; Pancreaticoduodenectomy.

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Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Cohort flow diagram. PD, pancreatoduodenectomy; PDAC, pancreatic ductal adenocarcinoma; AA, ampullary carcinoma; CC, cholangiocarcinoma.
See this image and copyright information in PMC

References

    1. Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:240–258. doi: 10.1007/s00268-012-1771-1. - DOI - PubMed
    1. Cai J, Yang G, Tao Y, Han Y, Lin L, Wang X. A meta-analysis of the effect of early enteral nutrition versus total parenteral nutrition on patients after pancreaticoduodenectomy. HPB (Oxford) 2020;22:20–25. doi: 10.1016/j.hpb.2019.06.002. - DOI - PubMed
    1. Jeejeebhoy KN. Enteral nutrition versus parenteral nutrition-the risks and benefits. Nat Clin Pract Gastroenterol Hepatol. 2007;4:260–265. doi: 10.1038/ncpgasthep0797. - DOI - PubMed
    1. Xiong J, Szatmary P, Huang W, de la Iglesia-Garcia D, Nunes QM, Xia Q, et al. Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2016;95:e3497. doi: 10.1097/MD.0000000000003497. - DOI - PMC - PubMed
    1. Deng X, Cheng X, Huo Z, Shi Y, Jin Z, Feng H, et al. Modified protocol for enhanced recovery after surgery is beneficial for Chinese cancer patients undergoing pancreaticoduodenectomy. Oncotarget. 2017;8:47841–47848. doi: 10.18632/oncotarget.18092. - DOI - PMC - PubMed

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