Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

Table 1 General characteristics, comorbidities, and preoperative lab tests n (%)

	EEN + PN (n = 87)	TPN (n = 253)	P value
Sex (male)	43 (49.4)	155 (61.3)	0.053
Age (yr)	58 ± 1.5	58 ± 0.7	0.757
Smoking pack-years (≥ 20)	11 (12.6)	27 (10.7)	0.724
Alcoholic abuse	8 (9.2)	41 (16.2)	0.273
BMI	25.8 ± 4.9	25.5 ± 5.3	0.845
Body weight loss (n)
> 10%	27 (31.0)	86 (34.0)	0.426
Comorbidities
CAD	5 (5.7)	14 (5.5)	0.975
Hypertension	16 (18.4)	43 (17.0)	0.745
Diabetes mellitus	9 (10.3)	25 (9.9)	0.838
COPD	3 (7.0)	14 (5.5)	0.247
ASA classification ≥ 3	53 (60.9)	149 (58.9)	0.461
Hemoglobin (g/L)	118.3 ± 1.8	121.0 ± 1.0	0.194
Leukocytes (× 109/L)	7.0 ± 0.3	6.6 ± 0.2	0.227
Platelet (× 109/L)	217.8 ± 7.9	206.1 ± 5.0	0.224
Total bilirubin (μmol/L)	147.1 ± 16.3	144.6 ± 8.6	0.882
Alanine aminotransferase (U/L)	144.8 ± 14.7	151.5 ± 10.8	0.741
Aspartate aminotransferase (U/L)	122.2 ± 12.6	130.7 ± 10.8	0.622
Albumin (ng/mL)	43.7 ± 7.3	39.0 ± 1.6	0.345
Prothrombin time (s)	12.6 ± 0.1	12.8 ± 0.1	0.274
Fibronectin	4.5 ± 0.1	4.3 ± 0.1	0.253
Carcinoembryonic antigen (U/mL)	12.8 ± 1.9	3.7 ± 0.2	0.960
CA-125 (U/mL)	22.6 ± 2.2	26.5 ± 3.7	0.516
CA19-9 (U/mL)	657.4 ± 197.8	844.3 ± 236.3	0.645

BMI: Body mass index; EEN: Early postoperative enteral nutrition; PN: Parenteral nutrition; TPN: Total parenteral nutrition; CAD: Coronary atherosclerotic heart disease; COPD: Chronic obstructive pulmonary diseases; ASA: The American Society of Anesthesiologists.

Table 2 Pathological diagnosis of the primary disease n (%)

Pathology	EEN + PN (n = 87)	TPN (n = 253)	P value
Pancreatic adenocarcinoma	24 (27.6)	82 (32.4)	0.472
Bile duct adenocarcinoma	29 (33.3)	76 (30.0)	0.695
Duodenal/ampullary adenocarcinoma	27 (31.0)	64 (25.3)	0.391
Neuroendocrine tumor	2 (2.3)	4 (1.6)	0.583
Pancreatic pseudopapillary tumor	1 (1.1)	5 (2.0)	0.209
Cystic pancreatic tumor	1 (1.1)	3 (1.2)	0.754
Chronic pancreatitis/pancreatolithiasis	3 (3.4)	19 (7.5)	0.151

EEN: Early postoperative enteral nutrition; PN: Parenteral nutrition; TPN: Total parenteral nutrition.

Table 3 Intraoperative findings and postoperative presentation n (%)

	EEN + PN (n = 87)	TPN (n = 253)	P value
Diameter of pancreatic duct (cm)	0.7 ± 0.1	0.6 ± 0.0	0.483
Diameter of bile duct (cm)	1.8 ± 0.1	1.7 ± 0.0	0.188
Tumor max-diameter (cm)	3.7 ± 0.3	3.7 ± 0.2	0.964
Retrocolic choledochojejunostomy	85 (97.7)	227 (89.7)	0.212
Combined vascular resection	2 (2.3)	10 (4.3)	0.738
Intraoperative bleeding volume (mL)	753 ± 47.2	681 ± 59.4	0.426
Intraoperative blood transfusion	15 (17.2)	69 (27.3)	0.063
Duration of surgery (min)	329.5 ± 53.7	335.1 ± 61.3	0.461
Nasogastric tube retention (d)	9 ± 0.2	5 ± 0.1	0.006
Hospital stay (d)	32 ± 2	27 ± 1	0.074
Postoperative hospital stay (d)	25 ± 2	20 ± 1	0.055
Total cost (US dollars)	10397.0 ± 861.2	8663.9 ± 239.2	0.008

EEN: Early postoperative enteral nutrition; PN: Parenteral nutrition; TPN: Total parenteral nutrition.

Table 4 Postoperative complications n (%)

	EEN + PN (n = 87)	TPN (n = 253)	P value
Bile leakage	7 (8.0)	12 (4.7)	0.280
Pancreatic fistulas	13 (14.9)	27 (10.7)	0.334
Intraperitoneal infection	16 (18.4)	26 (10.3)	0.059
Intraperitoneal bleeding	1 (1.1)	10 (4.0)	0.301
Gastrointestinal bleeding	4 (4.6)	11 (4.3)	1.000
Pulmonary infection	9 (10.3)	9 (3.6)	0.024
Pulmonary embolism	0	1 (0.4)	1.000
Chylous leakage	1 (1.1)	3 (1.2)	1.000
Wound infection	8 (9.2)	23 (9.1)	1.000
Delayed gastric emptying	14 (16.1)	17 (6.7)	0.016
Grade B	9 (10.3)	11 (4.3)
Grade C	5 (5.7)	6 (2.4)
Unplanned reoperation	4 (4.6)	7 (2.8)	0.482
In-hospital death	2 (2.3)	4 (1.6)	0.204
EN-related complications	28 (32.2)	-
Abdominal distention	17 (19.5)	-
Abdominal cramps	15 (17.2)	-
Vomiting	10 (11.5)	-
Diarrhea	9 (10.3)	-

EEN: Early postoperative enteral nutrition; PN: Parenteral nutrition; TPN: Total parenteral nutrition.