Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy

Table 1 Ranges and averages of calories, protein, fat and carbohydrates in the enteral and parenteral regimens in the early enteral nutrition/parenteral nutrition group

POD	Nutritional support	Calories (kJ)	Protein (g)	Fat (g)	Carbohydrates (g)
1	PN	7649.4 (6081.9-10282.8)	91.5 (72.8-123.0)	67.1 (53.3-90.2)	305.0 (242.5-410.0)
	EN	83.6	0	0	5
2	PN	7649.4 (6081.9-10282.8)	91.5 (72.8-123.0)	67.1 (53.3-90.2)	305.0 (242.5-410.0)
	EN	418	0	0	25
3	PN	6447.6 (4880.1-9081.0)	84.0 (65.3-115.5)	59.6 (45.8-82.7)	257.5 (195.0-362.5)
	EN	1201.8	7.5	7.5	47.5
4	PN	5559.4 (3991.9-8192.8)	76.5 (57.8-108.0)	52.1 (38.3-75.2)	235.0 (172.5-340.0)
	EN	2090	15	15	70
5	PN	3469.0 (1901.9-6102.8)	61.5 (42.8-93.0)	37.1 (23.3-60.2)	165.0 (102.5-270.0)
	EN	4180	30	30	140
6	PN	0	0	0	0
	EN	7649.4 (6081.9-10282.8)	54.9 (43.65-73.8)	54.9 (43.65-73.8)	256.2 (203.7-344.4)

Data are expressed as absolute average or average (range). POD: Post-operation day; PN: Parenteral nutrition; EN: Enteral nutrition.

Table 2 Preoperative clinical data, intraoperative factors and histopathology of the patients enrolled in the study

	TPN group	EEN/PN group
Sex (male/female)	44/23	70/37
Age (yr)	52. 8 ± 11.2	53.9 ± 10.6
Intraoperative factors
Patients with jaundice (%)	79.1	83.2
Patients with preoperative ENBD (%)	50.7	48.6
Preoperative hemoglobin (g/L)	11.8 ± 1.0	12.4 ± 0.8
Preoperative albumin (g/L)	37.9 ± 3.1	36.8 ± 3.6
Duration of surgery (min)	345.1 ± 64.8	332.7 ± 56.6
Operative blood loss (mL)	648.4 ± 262.6	680.2 ± 193.7
Blood transfusion (%)	26.9	31.7
Histopathologic finding (n)
Pancreatic head carcinoma	24	37
Distal cholangiocarcinoma	19	31
Periampullary adenocarcinoma	21	34
Duodenal adenocarcinoma	3	5

EEN: Early enteral nutrition; ENBD: Endoscopic nasal biliary drainage; PN: Prognostic nutritional; TPN: Total parenteral nutrition.

Table 3 Comparison of nutrition-associated assessment in the two groups (mean ± SD)

	Normal value	Group	Day 1	Day 6	Decrease (days 1-6)
TP (g/L)	62-85	TPN	63.46 ± 7.24	59.92 ± 7.65	3.54 ± 1.72
		EEN/PN	64.11 ± 6.84	61.12 ± 6.83	2.99 ± 1.07
PAB (mg/L)	0-800	TPN	196.25 ± 64.32	116.52 ± 72.16a	79.73 ± 35.32
		EEN/PN	190.15 ± 62.18	158.32 ± 62.46	31.83 ± 13.15c
TF (g/L)	2.2-12	TPN	2.53 ± 0.76	2.20 ± 0.72	0.33 ± 0.61
		EEN/PN	2.46 ± 0.68	2.08 ± 0.81	0.38 ± 0.72
PNI	> 50	TPN	50.36 ± 9.14	43.12 ± 8.13	7.24 ± 7.40
		EEN/PN	51.62 ± 8.16	45.15 ± 9.52	6.47 ± 5.93
N-balance (g/d)		TPN	/	-(14.76 ± 6.03)	/
		EEN/PN	/	-(15.91 ± 7.85)	/

^aP < 0.05 vs day 1;

^cP < 0.05 vs total parenteral nutrition (TPN) group. PAB: Prealbumin; PNI: Prognostic nutritional index; TP: Total protein; TF: Transferrin; EEN: Early enteral nutrition; PN: Parenteral nutrition.

Table 4 Comparison of liver function in the two groups (mean ± SD)

	Normal value	Group	Day 1	Day 6	Decrease (days 6-1)
ALT (μ/L)	5-40	TPN	138.2 ± 48.4	82.5 ± 42.3a	55.7 ± 31.5
		EEN/PN	145.1 ± 39.2	77.4 ± 37.6a	67.7 ± 36.2
AST (μ/L)	8-40	TPN	97.6 ± 36.2	55.1 ± 31.5a	42.5 ± 26.2
		EEN/PN	102.3 ± 41.3	63.2 ± 36.3a	39.1 ± 22.0
TB (μmol/L)	5-20.5	TPN	112.5 ± 37.5	66.2 ± 29.4a	46.3 ± 34.3
		EEN/PN	106.8 ± 36.2	41.5 ± 34.1b	65.3 ± 36.2c
DB (μmol/L)	1.7-6.8	TPN	78.6 ± 30.2	38.1 ± 26.2a	40.5 ± 21.3
		EEN/PN	81.7 ± 35.6	22.4 ± 16.2b	59.3 ± 28.1c
LDH (μ/L)	109-245	TPN	332.6 ± 89.4	264.3 ± 101.3a	68.3 ± 51.2
		EEN/PN	316.2 ± 98.1	211.5 ± 86.2a	104.7 ± 76.8c

^aP < 0.05,

^bP < 0.01 vs day 1;

^cP < 0.05 vs total parenteral nutrition (TPN) group. PN: Prognostic nutritional; EEN: Early enteral nutrition; TB: Total bilirubin.

Table 5 Predictive risk score of major complications after pancreaticoduodenectomy in the two groups

Predictor	Categories	Risk Score	TPN group	EEN/PN group
Pancreatic texture (%)	Hard	0	43	73
	Soft	4	24	34
Pancreatic duct diameter (%)	> 3 mm	0	48	81
	≤ 3 mm	1	19	26
Operative blood loss (%)	< 700 mL	0	55	81
	≥ 700 mL	4	12	26
ASA score (%)	I	0	31	55
	II	2	33	47
	III	6	3	5
Score categorized in 4 risk classes n (%)	0-3		23 (34.3)	38 (35.5)
	4-7		22 (32.8)	33 (30.8)
	8-11		19 (28.4)	31 (29.0)
	12-15		3 (4.5)	5 (4.7)

ASA: American Society of Anesthesiologist; EEN: Early enteral nutrition; TPN: Total parenteral nutrition; PN: Prognostic nutritional.

Table 6 Postoperative outcome in the two groups n (%)

Group	TPN group	EEN/PN group
Complication Grade
No complications	24 (35.8)	42 (39.2)
I	33 (49.3)	38 (35.5)a
II	38 (56.7)	42 (39.3)a
IIIa	7 (10.4)	10 (9.3)
IIIb	4 (6.0)	5 (4.6)
IVa	0 (0.0)	0 (0.0)
IVb	0 (0.0)	0 (0.0)
V (mortality)	0 (0.0)	0 (0.0)
Reoperation	3 (4.5)	6 (5.6)
Readmission	2 (3.0)	3 (2.8)
Postoperative hospital stay (d)	16.8 ± 6.2	13.2 ± 4.7a

Numbers of single types of complications do not add up to the number of patients within the 2 groups, due to the possible occurrence of more types of complications in some patients.

^aP < 0.05 vs total parenteral nutrition (TPN) group. EEN: Early enteral nutrition; PN: Prognostic nutritional.

Table 7 Postoperative complications in the two groups n (%)

Complications	TPN group	EEN/PN group
Pancreatic fistula	2 (3.0)	4 (3.7)
Grade A	0 (0.0)	0 (0.0)
Grade B	2 (3.0)	4 (3.7)
Grade C	0 (0.0)	0 (0.0)
Wound infection	8 (11.9)	10 (9.3)
Abdominal abscess	7 (10.4)	6 (5.6)
Bile leak	5 (7.5)	7 (6.5)
Cholangitis	4 (6.0)	3 (2.8)
Urinary tract infection	5 (7.5)	6 (5.6)
Pneumonia	8 (11.9)	6 (5.6)
Catheter-related sepsis	0 (0.0)	0 (0.0)
Gastrointestinal bleeding	4 (6.0)	5 (4.7)
Intraperitoneal bleeding	3 (4.5)	6 (5.6)
Delayed gastric emptying	11 (16.4)	6 (5.6)
Enteral-feeding-related complications	0 (0.0)	29 (27.1)
Abdominal cramps	0 (0.0)	6 (5.6)
Abdominal distention	0 (0.0)	11 (10.3)
Diarrhea	0 (0.0)	9 (8.4)
Vomiting	0 (0.0)	3 (2.8)
Hyperglycemia	12 (17.9)	6 (5.6)

Numbers of single types of complications do not add up to the number of patients within the 2 groups, due to the possible occurrence of more types of complications in some patients. EEN: Early enteral nutrition; PN: prognostic nutritional; TPN: Total parenteral nutrition.