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Early enteral nutrition after pancreatoduodenectomy: a meta-analysis of randomized controlled trials

  • Systematic Reviews and Meta-analyses
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of our study was to evaluate the safety and effectiveness of early enteral nutrition (EN) for patients after pancreatoduodenectomy (PD).

Methods

We performed a comprehensive search of abstracts in the MEDLINE database, OVID database, Springer database, the Science Citation Index, and the Cochrane Library database. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of early EN and other nutritional routes for patients after PD were analyzed. The analyzed outcome variables included gastroparesis, intra-abdominal complications (gastroparesis excluded), mortality, infection, and postoperative hospital stay. The Cochrane Collaboration’s RevMan 5.1 software was used for statistical analysis.

Results

Four RCTs published in 2000 or later were included in this meta-analysis, in which 246 patients underwent early EN and 238 patients underwent other nutritional routes following PD. In the combined results of early EN versus other nutritional routes, no significant difference could be found in gastroparesis (odds ratio (OR), 0.89; 95 % CI, 0.36–2.18; P = 0.79), intra-abdominal complications (gastroparesis excluded) (OR, 0.82; 95 % CI, 0.53–1.26; P = 0.37), mortality (OR, 0.43; 95 % CI, 0.11–1.62; P = 0.21), infection (OR, 0.55; 95 % CI, 0.29–1.07; P = 0.08), postoperative hospital stay (mean difference, −0.93; 95 % CI, −6.51 to 4.65; P = 0.74).

Conclusions

Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.

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References

  1. Sakorafas GH, Friess H, Balsiger BM et al (2001) Problems of reconstruction during pancreatoduodenectomy. Dig Surg 18:363–369

    Article  PubMed  CAS  Google Scholar 

  2. Sarr MG for the Pancreatic Surgery Group (2003) The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 196:556–565

    Article  Google Scholar 

  3. Suc B, Msika S, Piccinini M et al (2004) Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial. Arch Surg 139:288–294

    Article  PubMed  Google Scholar 

  4. Chan C, Franssen B, Domínguez I et al (2012) Impact on quality of life after pancreatoduodenectomy: a prospective study comparing preoperative and postoperative scores. J Gastrointest Surg 16:1341–1346

    Article  PubMed  Google Scholar 

  5. Edward L, Bradley III (2008) Long-term survival after pancreatoduodenectomy for ductal adenocarcinoma: the emperor has no clothes? Pancreas 37:349–351

    Article  Google Scholar 

  6. Wente N, Shrikhande SV, Muller MW et al (2007) Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 193:171–183

    Article  PubMed  Google Scholar 

  7. Thomas S, David BA (2005) The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg 71:466–472

    Google Scholar 

  8. Correia MI, Caiaffa WT, Silva AL et al (2001) Risk factors for malnutrition in patients undergoing gastroenterological and hernia surgery: an analysis of 374 patients. Nutr Hosp 16:59–64

    PubMed  CAS  Google Scholar 

  9. Weimann A, Braga M, Harsanyi L et al (2006) ESPEN guidelines on EN: surgery including organ transplantation. Clin Nutr 25:224–244

    Article  PubMed  CAS  Google Scholar 

  10. (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 26 (1): 1SA–138SA. doi: 10.1177/0148607102026001011

  11. Jang JY, Kim SW, Han JK et al (2003) Randomized prospective trial of the effect of induced hypergastrinemia on the prevention of pancreatic atrophy after pancreatoduodenectomy in Humans. Ann Surg 237:522–529

    PubMed  Google Scholar 

  12. (1991) Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med. 325:525–532.

  13. Beier-Holgersen R, Boesby S (1997) Influence of postoperative enteral nutrition on postsurgical infections. Gut 39:833–835

    Article  Google Scholar 

  14. Slotwinski R, Olszewski WL, Slotkowski M et al (2007) Can the interleukin-1 receptor antagonist (IL-1ra) be a marker of anti-Inflammatory response to enteral immunonutrition in malnourished patients after pancreaticoduodenectomy? JOP J Pancreas (Online) 8:759–769

    Google Scholar 

  15. Brennan MF, Pisters PWT, Posner M, Queseda O, Shike M (1994) A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy. Ann Surg 220:436–44

    Article  PubMed  CAS  Google Scholar 

  16. Gianotti L, Braga M, Gentilini O et al (2000) Artificial nutrition after pancreaticoduodenectomy. Pancreas 21:344–351

    Article  PubMed  CAS  Google Scholar 

  17. Mack LA, Kaklamanos IG, Livingstone AS et al (2004) Gastric decompression and enteral feeding through a double-lumen gastrojejunostomy tube improves outcomes after pancreaticoduodenectomy. Ann Surg 240:845–51

    Article  PubMed  Google Scholar 

  18. Grižas S, Gulbinas A, Barauskas G et al (2008) A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy. Medicina (Kaunas) 44:678–686

    Google Scholar 

  19. Tien YW, Yang CY, Wu YM et al (2009) Enteral nutrition and biliopancreatic diversion effectively minimize impacts of gastroparesis after pancreaticoduodenectomy. J Gastrointest Surg 13:929–937

    Article  PubMed  Google Scholar 

  20. Hikohiro A, Shiro M, Jun O et al (2009) Enteral supplementation enriched with glutamine, fiber, and oligosaccharide prevents gut translocation in a bacterial overgrowth model. J Trauma 66:110–114

    Article  Google Scholar 

  21. Lin MT, Saito H, Fukushima R et al (1996) Route of nutritional supply influences local, systemic, and remote organ responses to intraperitoneal bacterial challenge. Ann Surg 223:84–93

    Article  PubMed  CAS  Google Scholar 

  22. Braga M, Gianotti L, Vignali A et al (1998) Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med 26:24–30

    Article  PubMed  CAS  Google Scholar 

  23. Bozzetti F, Braga M, Gianotti L et al (2001) Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomized multicentre trial. Lancet 358:1487–1492

    Article  PubMed  CAS  Google Scholar 

  24. Martignoni ME, Friess H, Sell F et al (2000) Enteral nutrition prolongs delayed gastric emptying in patients after Whipple resection. Am J Surg 180:18–23

    Article  PubMed  CAS  Google Scholar 

  25. Kurosaki I, Hatakeyama K (2005) Preservation of left gastric vein in delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg 9:846–852

    Article  PubMed  Google Scholar 

  26. Kollmar O, Moussavian MR, Richter S et al (2008) Prophylactic octreotide and delayed gastric emptying after pancreaticoduodenectomy: results of a prospective randomized double-blinded placebo-controlled trial. Eur J Surg Oncol 34:868–875

    Article  PubMed  CAS  Google Scholar 

  27. Yeo CJ, Cameron JL, Lillemore KD et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236:355–366

    Article  PubMed  Google Scholar 

  28. Kurahara H, Shinchi H, Maemura K et al (2011) Delayed gastric emptying after pancreatoduodenectomy. J Surg Res 171:e187–92

    Article  PubMed  Google Scholar 

  29. Okabayashi T, Kobayashi M, Nishimori I et al (2006) Benefits of early postoperative jejunal feeding in patients undergoing duodenohemipancreatectomy. World J Gastroenterol 12:89–93

    PubMed  Google Scholar 

  30. Peng SY, Wang JW, Lau WY et al (2007) Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 245:692–698

    Article  PubMed  Google Scholar 

  31. Fernandez-Cruz L, Blanco L, Lopez-Boado MA et al (2008) Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 248:930–938

    Article  PubMed  Google Scholar 

  32. Van Berge Henegouwen MI, Akkermans LM, van Gulik TM et al (1997) Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy. Ann Surg 226:677–685

    Article  PubMed  Google Scholar 

  33. Rayes N, Seehofer D, Theruvath T et al (2007) Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind Trial. Ann Surg 246:36–41

    Article  PubMed  Google Scholar 

  34. Kalfarentzos F, Kehagias J, Mead N et al (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 84:1665–1669

    Article  PubMed  CAS  Google Scholar 

  35. Eckerwall GE, Axelsson JB, Andersson RG (2006) Early nasogastric feeding in predicted severe acute pancreatitis: a clinical, randomized study. Ann Surg 244:959–965

    Article  PubMed  Google Scholar 

  36. McClave SA, Martindale RG, Vanek VW et al (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 33:277–316

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Scientific Research Fund from Hubei University of Chinese Medicine and Young Talents Project of Science and Technology Research Program from Hubei Provincial Department of Education (grant no. Q20132003).

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Authors and Affiliations

  1. Department of Surgery, Hubei Hospital of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, 430061, People’s Republic of China

    YinFeng Shen & WenYin Jin

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  1. YinFeng Shen
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  2. WenYin Jin
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Correspondence to WenYin Jin.

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Shen, Y., Jin, W. Early enteral nutrition after pancreatoduodenectomy: a meta-analysis of randomized controlled trials. Langenbecks Arch Surg 398, 817–823 (2013). https://doi.org/10.1007/s00423-013-1089-y

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  • DOI: https://doi.org/10.1007/s00423-013-1089-y

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