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. 2025 May 7;9(3):zraf068.
doi: 10.1093/bjsopen/zraf068.

Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: nationwide study

Tessa E Hendriks  1   2   3   4 , Bo T M Strijbos  5 , Michiel F G Francken  1   2 , Mahsoem Ali  1   2 , J Annelie Suurmeijer  1   2 , Marcel G W Dijkgraaf  6   7 , Jana S Hopstaken  5 , Kees van Laarhoven  5 , Quintus Molenaar  8 , Vincent E de Meijer  9 , Erwin van der Harst  10 , Marcel den Dulk  11   12 , Werner Draaisma  13 , Vincent Nieuwenhuijs  14 , Michael F Gerhards  15 , Mike S L Liem  16 , George van der Schelling  17 , Eric Manusama  18 , Ignace de Hingh  19 , Hjalmar van Santvoort  7 , Bas Groot Koerkamp  20 , Olivier R Busch  1   2 , Bert A Bonsing  3 , Martijn W J Stommel  5 , Marc G Besselink  1   2 ; Dutch Pancreatic Cancer Group (DPCG) and Dutch Institute for Clinical Auditing (DICA)
Collaborators, Affiliations

Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: nationwide study

Tessa E Hendriks et al. BJS Open. .

Abstract

Background: Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay.

Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined.

Results: Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05).

Conclusion: This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.

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Figures

Fig. 1
Fig. 1
Trend in the annual rate of DGE grade B/C after PD in the Netherlands (2014–2023) Shaded area represents 95% confidence interval. DGE, delayed gastric emptying; PD, pancreatoduodenectomy.
Fig. 2
Fig. 2
Centre-specific rate of DGE after PD (2021–2023) and routine feeding strategy per centre in relation to 3-year surgical volume DGE, delayed gastric emptying; PD, pancreatoduodenectomy; c.i., confidence interval.
Fig. 3
Fig. 3
Predictors of DGE grade B/C after PD *In addition to the primary tumour, adjacent structures or organs were removed (such as mesocolon transversum, gastric resection). †Preoperative biliary stenting. ‡Pre-existing diabetes. §Pancreatojejunostomy versus pancreatogastrostomy. ¶Pylorus resection versus pylorus-preserving. DGE, delayed gastric emptying; PD, pancreatoduodenectomy; POPF, postoperative pancreatic fistula; PPH, postpancreatectomy haemorrhage grade B/C; CCI, Charlson Co-morbidity Index; ASA, American Society of Anesthesiologists; PDAC, pancreatic ductal adenocarcinoma; MIPD, minimally invasive pancreatoduodenectomy; BMI, body mass index.
See this image and copyright information in PMC

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