Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3821-3828
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3821
Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center
Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Xue-Min Liu, Yi Lv, Xu-Feng Zhang
Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jian-Wen Lu, Chang Liu, Zhao-Qing Du, Yi Lv, Xu-Feng Zhang, Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi’an 710061, Shaanxi Province, China
Xue-Min Liu, Department of Health Statistics, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Lu JW, Lv Y and Zhang XF contributed equally to this work; Zhang XF and Lv Y conceived and designed the experiments; Lu JW, Liu C and Yin GZ performed the experiments; Lu JW, Liu XM and Du ZQ analyzed the data; Lu JW and Liu XM contributed reagents/materials/analysis tools; Lu JW, Lv Y and Zhang XF wrote the paper.
Supported by the National Natural Science Foundation, No. 81372582; “New-Star” Young Scientists Program of Shaanxi Province, No. 2014kjxx-30; and the Fundamental Research Funds for the Central Universities.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Xi’an Jiaotong University Institutional Review Board.
Informed consent statement: Informed written consent was provided by each participant or the participant’s legal guardian prior to enrollment in the study.
Conflict-of-interest statement: The authors have declared that no competing interests exist.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at the following email address: xfzhang125@126.com. The participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xu-Feng Zhang, MD, PhD, Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China. xfzhang125@126.com
Telephone: +86-29-82657541 Fax: +86-29-82653905
Received: August 30, 2015
Peer-review started: September 1, 2015
First decision: September 29, 2015
Revised: October 22, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: April 14, 2016
Processing time: 212 Days and 14.3 Hours
Abstract

AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).

METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed.

RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.

CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.

Keywords: Pancreaticoduodenectomy; Postoperative complications; Enteral nutrition; Parenteral nutrition; Delayed gastric emptying

Core tip: Although most studies have shown that early enteral nutrition (EEN) seems to be superior to total parenteral nutrition (TPN) in postoperative outcomes, the optimal nutritional support route choice after pancreaticoduodenectomy (PD) remains debatable. In this retrospective study, we investigated postoperative outcomes between patients undergoing TPN and EEN + PN after PD. The results demonstrated that the EEN + PN group had an increased morbidity of delayed gastric emptying and pulmonary infection, which might account for longer nasogastric tube retention time, postoperative hospital stay and higher hospitalization expenses. In our opinion, EEN should only be performed cautiously and selectively.