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Routes of nutrition for pancreatic fistula after pancreatoduodenectomy: a prospective snapshot study identifies the need for therapy standardization

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Abstract

The aim of this study is to describe the current utilization of artificial nutrition [enteral (EN) or total parenteral (TPN)] for pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Prospective data of 311 patients who consecutively underwent PD at a tertiary referral center for pancreatic surgery were collected. Data included the use of EN or TPN specifically for POPF treatment, including timing, outcomes, and adverse events related to their administration. POPF occurred in 66 (21%) patients and 52 (79%) of them were treated with artificial nutrition, for a median of 36 days. Forty (76%) patients were treated with a combination of TPN and EN. The median day of artificial nutrition start was postoperative day 7, with a median drain output of 180 cc/24 h. In 33 (63%) patients, artificial nutrition was started while only a biochemical leak was ongoing. Fungal infections and catheter-related bloodstream infection occurred in 13 (28%) and 15 (33%) TPN patients, respectively; among EN patients, 19 (41%) experienced diarrhea not responsive to pancreatic enzymes and 9 (20%) needed multiple endoscopic naso-jejunal tube positioning. The majority of the patients developing POPF after PD were treated with a combination of TPN and EN, with a clinically relevant rate of adverse events related to their administration. Standardization of nutrition routes in patients developing POPF is urgently needed.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, CB.

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Authors and Affiliations

  1. Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy

    Giampaolo Perri, Giovanni Marchegiani, Elisa Romandini, Alice Cattelani, Gaetano Corvino, Claudio Bassi & Roberto Salvia

  2. Department of Surgery and Oncology, General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital, P.le Scuro 10, 37134, Verona, Italy

    Claudio Bassi

Authors
  1. Giampaolo Perri
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  2. Giovanni Marchegiani
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  3. Elisa Romandini
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  4. Alice Cattelani
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  5. Gaetano Corvino
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  6. Claudio Bassi
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  7. Roberto Salvia
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Correspondence to Claudio Bassi.

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The authors declare that they have no conflicts of interest to declare.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee of the University of Verona approved this study with the number: 298CESC.

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All patients signed a written informed consent to be included in the clinical data registry (PAD-R) recording information to be used for prospective or retrospective studies.

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Perri, G., Marchegiani, G., Romandini, E. et al. Routes of nutrition for pancreatic fistula after pancreatoduodenectomy: a prospective snapshot study identifies the need for therapy standardization. Updates Surg 75, 1431–1438 (2023). https://doi.org/10.1007/s13304-023-01501-y

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  • DOI: https://doi.org/10.1007/s13304-023-01501-y

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