Early Versus Late Oral Refeeding After Pancreaticoduodenectomy for Malignancy: a Comparative Belgian-French Study in Two Tertiary Centers

  • Julie Navez
  • Catherine Hubert
  • Safi Dokmak
  • Isadora Frick De La Maza
  • Nicolas Tabchouri
  • Olivier Benoit
  • Hélène Hermand
  • Francis Zech
  • Jean-François Gigot
  • Alain SauvanetEmail author
Original Article



In the era of fast-track surgery, because pancreaticoduodenectomy (PD) carries a significant morbidity, surgeons hesitate to begin early oral feeding and achieve early discharge. We compared the outcome of two different approaches to the postoperative management of PD in two tertiary centers.


Of patients having undergone PD for malignancy from 2008 to 2017, 100 patients who received early postoperative oral feeding (group A) were compared to 100 patients from another center who received early enteral feeding and a delayed oral diet (group B). Surgical indication and approach and type of pancreatic anastomosis were similar between both groups. Postoperative outcomes were retrospectively reviewed.


Patient characteristics were similar between both groups, except significantly more neoadjuvant treatment in group A (A = 20% vs. B = 9%, p < 0.01). Mortality rates were 3% and 4% in groups A and B, respectively (p = 0.71). The rate of severe postoperative morbidity was significantly lower in group A (13% vs. 26%, p = 0.02), resulting in a lower reoperation rate (p < 0.01). Delayed gastric emptying and clinically relevant pancreatic fistula were similar between both groups but chyle leaks were more frequent in group A (10% vs. 3%, p = 0.04). The median hospital stay was shorter in group A (16 vs. 20 days, p < 0.01).


In the present study, early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula. However, it resulted in more chyle leaks and did not prevent delayed gastric emptying.


Pancreaticoduodenectomy Early oral feeding Pancreatic fistula Delayed gastric emptying Chyle leaks 


Authors’ Contribution

All authors have contributed significantly to the study, according to the guidelines of the International Committee of Medical Journal Editors (ICMJE).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that have no conflict of interest.

Supplementary material

11605_2019_4316_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Julie Navez
    • 1
    • 2
  • Catherine Hubert
    • 1
  • Safi Dokmak
    • 2
  • Isadora Frick De La Maza
    • 1
  • Nicolas Tabchouri
    • 2
  • Olivier Benoit
    • 2
  • Hélène Hermand
    • 2
  • Francis Zech
    • 3
  • Jean-François Gigot
    • 1
  • Alain Sauvanet
    • 2
    Email author
  1. 1.Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and TransplantationCliniques Universitaires Saint-LucBrusselsBelgium
  2. 2.Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l’Appareil Digestif, et Université Paris VIIHôpital Beaujon, AP-HPParisFrance
  3. 3.Institute of Experimental and Clinical ResearchCliniques Universitaires Saint-LucBrusselsBelgium

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